Prenatal Screening and Control of Severe Thalassemia Under the National Universal Health Coverage in Chiang Mai

Abstract

Abstract: Universal prenatal screening and control of severe thalassemia in Chiang Mai comprised 5 steps, namely. 1. Couple counseling 2. Screening for thalassemnia caniers by Osmotic fraghlity test (OFT) and Hemoglobin E (Hb E) screen 3. Identification of the risk couples by microcolumn A, quantitation and PCR for SEA-type B-thalassemia 4. Prenatal diagmosis and 5. Post-counseling and consideration for termination of pregnancy. Atter the commencement of the National Universal Health Coverage Plan, the Chiang Mai Provincial Public Health Office and the Faculty of Medicine of Chiang Mai University developed a thalassemia screening and control network in Chiang Mai. Couple counseling and primary screening were initiated in community hospitals. The informative blood samples were further sent to the Faculty of Medicine. In 2003, 10,122 couples were screened and 249 at-risk fetuses underwent a prenatal diagmosis. Forty-five tetuses were given a diagnosis of severe thalassemia; 11 with homozygous B-thalassemia, 22 with Ho Bart's hydrops fetalis and 12 with Hb E/B-thalassemia. The ratio of homozygous B-thalassemia and Ho Bart's hydrops fetalis was consistent with a calculated risk from the gene frequencies. At 250 bahts per couple for the process of screening through fetal diagmosis, the benefit to cost ratio was 20.6:1. Further development of a clinical and laboratory referral network and establishment of an advisory center is suggested.