Mayir Index – Globally Integrated Diagnostic Model

Globally Integrated Algorithm 5-Step Protocol

Innovation: The Mayir Index is a unified diagnostic model that integrates CBC‑based prediction (Steps 1‑3) with confirmatory tests (Step 4) and demographic adjustments (age, sex, pregnancy, ethnicity) based on global reference data. A final weighted integration (Step 5) produces a coherent diagnostic impression with transparent probability percentages.

Step 1 – Calculation: Mayir Index computed from MCV, RBC, RDW (formula withheld for IP protection).
Step 2 – Primary Classification: Index < cutoff → suggests TT; Gray Zone (cutoff ±10); > cutoff+10 → suggests IDA.
Step 3 – RDW Confirmation: If > cutoff+10, RDW > 15% supports IDA; RDW ≤ 15% raises suspicion for δ/β/silent carriers.
Step 4 – Confirmatory Integration: Each test (HbA2, ferritin, iron/TIBC, HbF) is interpreted as supporting, contradicting, or modifying the index‑based prediction, with demographic adjustments.
Step 5 – Weighted Final Impression: All data (index, RDW, confirmatory tests, demographics) are combined into a weighted model, producing a final impression with percentage probabilities for each category (IDA, Thalassemia, Mixed, ACD, Other).

References for Demographic Adjustments:
• WHO Haemoglobin Cutoffs (2011, 2024) – Anemia thresholds by age, sex, and pregnancy.
• Omuse G, et al. (2018) – CBC reference intervals in Kenyan adults (African population).
• Qiao R, et al. (2014) – CBC reference intervals in Chinese Han population.
• Lim E, et al. (2015) – Ethnic variations in laboratory tests.
• Patel AP (2018) – Cutoffs for Western Indian population.
• Sirdah et al. (2012) – Discrimination indices in Palestine.
• Urrechaga (2012) – Mentzer Index performance in Spain.
• Ehsani et al. (2009) – Mentzer Index in Iran.
• Nalbantoğlu et al. (2008) – Indices in Turkish children.
• Ferrara et al. (2007) – Indices in Italian children.
• Bessman JD, et al. (1983) – RDW > 15% as marker for IDA.

Legal & Ethical Neutrality: This tool provides supportive, probabilistic interpretations. It does not diagnose. All results must be clinically correlated. The final responsibility rests with the attending clinician.

Step 1–3: CBC & Demographic Assessment Enter Values

Provide CBC parameters and demographic information for context‑adjusted interpretation.

RBC (×10¹²/L)

MCV (fL)

RDW (%)

Age (years)

Sex

Pregnancy (if female)

Ethnicity / Region

Step 4: Confirmatory Integration Enter available results

Enter any available confirmatory test results. Each test will be evaluated in the context of the index and demographics.

HbA2 (%)

Ferritin (ng/mL)

Serum Iron (µg/dL)

TIBC (µg/dL)

HbF (%)

Interpretation & Confirmatory Pathway

Pattern Suggestive of Beta‑Thalassemia Trait (Index < Cutoff)

Confirmatory tests: Hb electrophoresis + HbA2 (elevated >3.5% supports BTT). HbF if indicated.
Serum ferritin and iron studies to exclude co‑existing iron deficiency.
Clue: Elevated RBC with RDW < 15% supports this pattern.

Pattern Compatible with Iron Deficiency Anemia (Index > Cutoff+10, RDW > 15%)

Essential panel: ferritin (low), iron (low), TIBC (high), Tsat (<15%).
CRP to exclude inflammatory block (functional ID).
Clue: Low/normal RBC with RDW > 15% supports this pattern.

Safety Net: Possible δ/β‑Thalassemia or Silent Carrier (Index > Cutoff+10, RDW ≤ 15%)

Atypical for IDA – consider delta‑beta thalassemia (raised HbF), silent beta‑thalassemia (normal HbA2/HbF), or alpha+beta co‑inheritance.
Workup: Hb electrophoresis (HbA2, HbF, variants) + globin gene analysis.

Gray Zone (Cutoff ±10) – Comprehensive Evaluation

Possible: early IDA, mild thalassemia, combined deficiency, or early ACD.
Stepwise: Repeat CBC + iron panel + Hb electrophoresis + CRP + peripheral smear.
Note: Gray zone is dynamically adjusted based on demographics to minimize missing thalassemia variants.

References

WHO Haemoglobin Cutoffs (2011, 2024) – Anemia thresholds by age, sex, and pregnancy.
Omuse G, et al. (2018) – CBC reference intervals in Kenyan adults.
Qiao R, et al. (2014) – CBC reference intervals in Chinese Han.
Lim E, et al. (2015) – Ethnic variations in laboratory tests.
Patel AP (2018) – Cutoffs for Western Indian population.
Sirdah et al. (2012) – Discrimination indices in Palestine.
Urrechaga (2012) – Mentzer Index performance in Spain.
Ehsani et al. (2009) – Mentzer Index in Iran.
Nalbantoğlu et al. (2008) – Indices in Turkish children.
Ferrara et al. (2007) – Indices in Italian children.
Bessman JD, et al. (1983) – RDW > 15% as marker for IDA.