Screening for prevention and control of severe thalassemia at Maung Saung Hospital, Roiet province: 6 years of experience

Abstract

Prevention and control program of thalassemia and hemoglobinopathies has been carried out at Maung Saung hospital, Roiet province for years according to the policy of the Ministry of Public Health. All pregnant women and thier husbands, who attended the antenatal care services at the hospital are screened for thalassemia using a combined osmotic fragility test (KKU-OF) and dichlorophenolindophenol test (KKU-DCIP-Clear). Blood samples of couples with positive screen results are transferred to Roiet hospital for further Hb analysis. In order to evaluate the performance of the program, retrospective data were collected and analyzed. Subjects were 670 pregnant women with the average gestational age of 14.0 weeks, attended during 2005-2010. The proportion of positive screened pregnant women in 2005, 2006, 2007, 2008, 2009 and 2010 were 33.6, 42.2, 43.5, 51.6 and 47.5 %, respectively. Among those with positive screens, 43.6, 49.0, 80.9, 93.8, 79.6 and 93.1% of their husbands were called and screened for thalassemia. During these 6 years of services, 63 of 217 couples (29.0 %) were found to be at-risk couples. Of these 63 couples, 4 (6.4 %) were found to be at risk for having fetuses with homozygous α⁰-thalassemia (Hb Bart’s hydrops fetalis). However all of them were not subjected to DNA analysis for a⁰-thalassemia. Nonetheless, no newborn with Hb Bart’s hydrops fetalis was encountered at Maung Saung hospital during 2005-2009. The average laboratory expense for identification of at risk couples was 23,000 bath / year, much cheaper than that use for treatment of a new case with severe thalassemia disease. In order to improve the service of prevention and control program of thalassemia, it is suggested that the antenatal care unit, laboratory and genetic counseling unit should work together properly. Efficiency in calling of the husband for blood test, simple laboratory interpretation and counseling guideline for the physician should also be developed.