2018 4th International Conference on Computer and Technology Applications
Decision Support System for Diagnosing Anemia
Saule Belginova
Department of Information Technologies
D. Serikbayev East Kazakhstan state technical university
Ust-Kamenogorsk, Kazakhstan
e-mail: saule.belginova@mail.ru
Aigerim Ismukhamedova
Department of Information Technologies
D. Serikbayev East Kazakhstan state technical university
Ust-Kamenogorsk, Kazakhstan
e-mail: Aigerim_ismuhamedova@mail.ru
Abstract—Paper describes the features of building medical
knowledge bases, shows an example of the construction of rules
and the implementation of logical conclusion in such systems.
The general scheme of constructing of medical expert systems
for the diagnosis of anemia is presented. The stages of building
a medical knowledge base and examples of writing logical rules
are presented.
Keywords-medical expert system; anemia; decision making
technology; diagnosis; knowledge base technology
I. INTRODUCTION
One of the widely applicable areas of application of
expert systems in medicine is medical diagnostics. Medical
diagnosis systems help to establish a link between
impairments in the functioning of the human body and their
possible causes. The list of the most important advantages of
medical expert systems is as follows:
- The knowledge base assumes work with complex
multicomponent systems that complement each other;
- Information is extracted from primary data
(biochemical blood tests, ECG signals);
- Diagnosis of faults (both in technical systems and in the
human body);
- The possibility of carrying out structural analysis of
complex objects (for example, biochemical compounds);
- The ability to schedule the sequence of ongoing
operations to achieve the goal (a sequence of therapeutic
solutions);
- The ability to conduct a large number of complex tasks
in a short period of time (for example, analysis of medical
data, clarification of diagnosis in doubtful cases and lack of
sufficient knowledge in highly specialized areas) [1].
Thus, the use of modern information technologies is
becoming an important factor in the development of practical
activities in the field of medicine, and research in this area is
one of the most urgent tasks of the medical field.
This paper considers an expert system that meets the
general requirements of software complexes in the field of
978-1-5386-6995-2/18/$31.00 ©2018 IEEE 211
Indira Uvaliyeva
Department of Information Technologies
D. Serikbayev East Kazakhstan state technical university
Ust-Kamenogorsk, Kazakhstan
e-mail: indirauvalieva@gmail.com
medicine, which intendeds to diagnose anemia, and
determining the stage of the disease development.
Iron deficiency anemia is a global problem in the
healthcare system of various countries. According to experts
of the World Health Organization (WHO), anemia affects
about 40% of the total population in the world, while
women’s anemia is detected three times more often than
men’s are. During pregnancy, a decrease in hemoglobin in
the blood is found in 50% of women, of whom anemia due to
iron deficiency reaches 90%. Less often, anemia is
associated with other causes, for example, with a deficiency
of vitamin B12 and folic acid [2].
Iron deficiency anemia (IDA) is the most common
nutritional deficiency worldwide. It can cause reduced work
capacity of adults and impact motor and mental development
of children and adolescents. There are some evidences that
iron deficiency without anemia affects cognition in
adolescent girls and causes fatigue in adult women. IDA may
affect visual and auditory functioning3 and is weakly
associated with poor cognitive development in children. [3].
The research task of the statement is the system analysis
of the process of diagnostics of anemia species. It is
necessary to develop a knowledge base for an expert system
for the diagnosis of anemia, which will provide support to
decision-making by the doctor when diagnosing a patient
and when prescribing treatment.
The main function of the expert system being developed
is to analyze and analyze existing problems; creation of
expert systems for business and skills reduction.
II. RELATED WORKS
The authors of Norman I. Birndorf, James R. Coakley
and Kent A. Spackman developed a hybrid expert system
that combines rule-based and artificial neural network (ANN)
models for the evaluation of microcytic anemia in a three-
layer program using hematocrit (HCT), medium corpuscular
volume (MCV) and the cell distribution width change factor
(RDWcv) as inputs. These measurements are available as a
standard output on most hematological analyzers. Three
categories of microcytic anemia, iron deficiency (IDA), - symptoms of tissue deficiency of iron appear.
hemoglobinopathy (HEM) and chronic disease anemia (ACD) III stage - iron deficiency anemia.
were considered. An attempt has been made to create an Technique of using criteria: one indicator of group A is
expert system with sufficient accuracy to diagnose anemia estimated at 1 point, the same indicator of group B - in 2
classes and to report suspected diagnoses directly to the points, and in group C - in 3 points.
hematological form. A new feature of the model is its The proposed system is suitable for estimating the
construction and training using only one expert expert [4]. prognosis of the severity of the disease, in particular iron
In the work of the authors Dubrovin A.V. and Fokin VA, deficiency anemia.
the concept of describing the results of medical and
biological research using an object-oriented approach is TABLE I. CLASSIFICATION SIGNS OF THE STAGE OF ANEMIA
proposed. Medico-biological research is represented by a Symptoms Points
certain algorithm of actions aimed at studying the properties Anemic syndrome: weakness, fatigue, Availability Avai Avai
of the object of investigation. Its formal description consists dyspnea, palpitations with exercise, (0,0-0,1) labili labili
in establishing the correspondence between the property of dizziness, pulsation; headache, ty ty
the object of investigation (the parameter being measured) memory impairment, decreased mental (1,0- (2,0-
performance, pale skin and mucous 2,0) 3,0)
and its value. Measurement of any parameter is characterized membranes, systolic murmur in cardiac
by appropriate conditions that must be fixed. The description auscultation.
of the study should include all the necessary information -
such as the description of indicators (laboratory, diagnostic, Sideropenic syndrome: a perversion of
taste, smell;
clinical, etc.), measurement conditions, etc. [5]. - skin: dryness, cracks;
The method used in [6] is a combination of fuzzy - mouth: cracks in the corners of the
diagnosis and prevention. mouth; Availability Avai Avai
During the diagnostic phase, the fuzzy operations - tongue: redness on the tip, cracks; (0,0-0,1) labili labili
performed have a number of outputs, some of which are used - hair: dull, split; ty ty
to announce the results, but some of the results remain - nails: puff, streak, waviness; (1,0- (2,0-
- teeth: dark enamel, caries develop, 2,0) 3,0)
unused. Therefore, to use all these results, according to the crumbles;
expert, some of them are used as information for prevention - Gastrointestinal tract: dysphagia;
purposes. Fuzzy inference operations for diagnosing diseases - Muscle: weakness;
have fuzzy results for each disease, but only one of the - a subfebrile condition (sometimes);
outputs will be used for diagnosis. Considering which output - Swelling of the feet;
- blue sclera.
is used for diagnosis and the distance that they have with the Concentration of iron in serum (μmol / Norm (N)
diagnosis, other means can be used in preventive L) (7-18)
applications. - in children under 2 years old (9-22)
In the research work [7], the proposed method for - in children from 2 to 14 years of age (11-31) <N <N
synthesizing decisive rules for the diagnosis of anemia, in - for men (8,9-30,4)
which, with the participation of highly qualified experts, - among women
Concentrations of serum ferritin (μg / <N
groups of characteristic subspaces are selected. Based on L) < (25-200) <N <N
expert judgment. Symptoms. - in newborns under 1 year of age < (30-140)
For each group of diagnostic features, a first level fuzzy - in children under 15 years of age < (20-250)
output module is synthesized, allowing one to aggregate the - for men < (12-120)
confidence for each group of diagnostic signs by the day type - among women
Transferrin (g / l) Norm (N)
of anemia in each group of diagnostic features. The creators
- in newborns (1,3-2,75) <N <N
of training samples for each diagnosed type of anemia. - in children from 3 months. under 16 (2,03-3,6)
years old
III. THE PROPOSED METHOD - for men 16-60 years old (2,15-3,65)
It is recognized that it is advisable to classify anemia, - in women 16-60 years old (2,5-3,8)
- in the elderly 60-90 years (1,9-3,75)
depending on the stage of development of the disease and Ferritin (μg / L) <N
severity. Depending on the activity of the process, which - in newborns up to 1 month. (25-200)
implies the severity of inflammatory reactions, three stages - from 1 to 2 months. (200-600) <N <N
are considered: - from 2 to 5 months. (50-200)
I stage (prelatent) - the reserve fund of iron is spent: - from 6 months. under 12 years old (7-140)
- men from 13 years old (30-310)
- the concentration of iron in the serum is normal;
- women from 13 years old (22-180)
- decrease in serum ferritin concentration. Total iron binding capacity of serum Norm (N)
II stage (latent) - clinical iron deficiency: - in newborns up to 1 month. (17,9-71,6)
- reduces the tissue and transport iron: - in adults (44,8-80,6) >N >N
• decrease in serum iron concentration;
• Increase in the total iron binding capacity of the serum; Data on the symptoms of iron deficiency anemia are
graphically presented in medical sources [8-11].

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 IV. CREATION OF A KNOWLEDGE BASE AND DECISION-
MAKING TECHNOLOGY
At the first stage, a knowledge base is created based on
the symptoms of the stages of development of iron
deficiency anemia and the parameters of the components of
the biochemical analysis of blood data.
Symptoms of IDA:
SI (x) = a1x1 + x2 + ... + xm are the symptoms of stage I;
SII (x) = xm + 1 + ... + xn are the symptoms of stage II;
SIII (x) = xn + 1 + ... + xl are the symptoms of stage III.
Figure 1 show stages of development of iron deficiency
states.
Figure 1. Stages of development of iron deficiency states
The diagnostic system is designed to solve two problems.
To successfully execute them, the process is divided into two
stages. The first task is to select patients who suffer from
symptoms of anemia, or screening, which is performed in the
first stage. The second task is differentiation, which allows to
differentiate anemia from the laboratory data of a
biochemical blood test (hemoglobin content in erythrocytes,
red blood cell volume, blood color indicator, etc.), which is
solved during the second stage of the diagnostic system.
This technique was proposed to differentiate
hypertensive disease in [1].
Thus, in order to be able to come to the conclusion in the
first stage, the user (in this case a doctor) must enter an
affirmative (yes) or negative (no) response for each presence
of the patient's symptom. Communication between the
computer system and the user is organized in the form of
questions and answers, which is familiar and understandable
to people.
In accordance with the given answers, corresponding
values are generated in the computer system. "Yes" is equal
to "1" and "no" to "0". Depending on the answers given, the
computer system assigns a corresponding score for each
symptom of anemic and sideropenic syndromes present.
Table I shows all possible outcomes of decision making in
the first stage - screening.
In the second stage, the aggregation of all parameters of
the functions gives a numerical value that must be compared
with the threshold values. The correspondence to a certain
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interval of numerical values of laboratory data is determined
using the logical rules "IF ... THEN ...". This approach, being
one of the oldest methods of representation of knowledge
about the subject area in the expert system, is widely used in
medical diagnostic systems [12-15].
Stages of development of iron deficiency states are
determined on the basis of the points scored according to the
classification features of the stage of anemia: prelatent - up
to 7 points inclusive, latent - 8-11 points, iron deficiency
anemia - 12-21 points. Stages of development of iron
deficiency anemia are presented in Figure 1 [16].
That is, the determination of the total results, which is
also performed by means of logical rules, gives the stage of
the development of the disease:
x IF S (x) İ 7 THEN prelatent stage;
x IF S (x)> 7 and S (x) İ 11 THEN latent stage of
development of iron deficiency anemia;
x IF ı 11 THEN for the diagnosis of the severity of
the disease, it is necessary to conduct additional
research.
The application of logical rules is well described in [17-
18].
At the next stage, the stage of development of iron
deficiency anemia is determined by the hemoglobin content:
x Light (content of Hb 90-120 g / l);
x Medium (the content of Hb is 70-90 g / l);
x Heavy (content of Hb below 70 g / l.
A tree of clinical solutions for determining the stage of
the disease and therapeutic decisions is given in Figure 2.
Figure 2. The decision tree for the stage of anemia
Correct use of biochemical blood test indicators helps to
establish the cause of hemoglobin decrease most simply and
quickly, and also to make a further classification of the
disease.
The algorithm for diagnosing iron deficiency anemia is
presented in Figure 3 [19].
Indicators of the components of the biochemical blood
test: MCH - hemoglobin content in erythrocytes, MCV - red
blood cell volume, De red blood cell diameter, RDW - red
cell abnormality, Ci - color index help to establish the cause
of hemoglobin decrease and establish a more accurate
diagnosis. To identify the type of anemia based on the values
of components and indicators of biochemical data analysis
and comparison with normative ones, a group of rules was
formulated [20]:
Rule 1: If MCV<80 and MCH<27 and MCHC<32 and
TC<0.85, then DIAGNOSIS = "Hypochromic microcytic
anemia".
Rule 2: If MCV = 80-95 and MCH = 27-31 and MCHC =
32-36 and TC = 0.85-1.0, then DIAGNOSIS = "Normocytic
normochromic anemia".
Rule 3: If MCV> 95 and MCH> 31 and MCHC = 32-36
and TC> 1.0, then DIAGNOSIS = "Hyperchromic
macrocytic anemia".
Figure 3. Algorithm for diagnosing anemia
Thus, the methods for calculating indicators and the
rules for setting dignosity are the algorithmic and
mathematical support of the system being developed [21].
V. DATABASE AND KNOWLEDGE BASE
A computer system creates a database, which consists of
computer files containing the following data: identification
data of the patient; the social status of the patient; history
data; sensations and complaints of the patient; medical
indicators (analyzes); information on the patient's medical
history; statistical information on the disease. To add data to
the knowledge base and accumulate logical rules of medical
content with the direct assistance of medical experts, an
automated questionnaire is used.
The developed protocol can serve as a reporting
document for the solution of the computer system. Files from
the database can be opened, edited, saved and printed. Based
on the available data, the computer system will be able to
assess the accuracy of the decision made by the specialist or
to correct the diagnosis. We also consider the possibility of
replenishing and updating the knowledge base, thereby
increasing the accuracy of the computer system.
VI. CONCLUSION
Technical information systems are reviewed. The
analysis of the process of diagnosis and treatment of iron
deficiency anemia is carried out. The structure of the
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knowledge base of the expert system is formed. Thus, the
use of expert systems to ensure the diagnosis of a patient and
choose a method of treatment can reduce the time of
admission and improve the effectiveness of treatment.
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