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Scoring System of Casanova et al for Identifying Iron Deficiency Anemia in a Pregnant Woman

Purpose: To evaluate a pregnant woman for iron deficiency anemia using the scoring system of Casanova et al.

Description

Casanova et al developed a scoring system for identifying iron deficiency in pregnant women. This can be helpful in evaluating a pregnant woman when more specific laboratory tests are unavailable. The authors are from the University of Pennsylvania in Philadelphia.


Pretest probability of iron deficiency: 50% (from page 460)

 

Parameters:

(1) hemoglobin

(2) RDW in percent

(3) gestational age in weeks

(4) combination of RDW and gestational age

 

Parameter

Finding

Points

hemoglobin

>= 9.7

0

 

< 9.7

1

red blood cell distribution width (RDW)

< 15 percent

0

 

>= 15 percent

1

gestational age

>= 20 weeks

0

 

< 20 weeks

1

combination

gestational age >= 20 OR RDW < 15

0

 

gestational age < 20 weeks AND RDW >= 15

1

 

where:

• Looking at the data in Table 1 (page 462), I am not sure why MCV did not appear in the final model. It would seem that an MCV < 80 fL would have identified the iron deficient women.

 

total score =

= SUM(points for all 4 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 4

• The cutoff to identify iron deficiency anemia was >= 2.

 

Performance:

• The specificity is good (88%), but the sensitivity is mediocre (45%). 74% of patients were correctly classified.

• How well the score would work in a population with a high frequency of thalassemia is uncertain. The authors claim that the score would be useful in resource-poor areas of the world. Unfortunately some of these areas also have high levels of thalassemia.


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Specialty

Objective

ICD-10