Author(s): Fucharoen G, Sanchaisuriya K, Saeung N, Dangwibul S, Fucharoen S
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Abstract OBJECTIVE: To evaluate a simple screening strategy for thalassaemia and haemoglobin (Hb) E in a prevention and control programme for thalassaemia in rural communities with limited resources. METHODS: Blood samples from 301 Thai-Khmer participants were screened for thalassaemia and Hb E using a combined modified one-tube osmotic fragility (OF) test and a modified dichlorophenolindophenol (DCIP) precipitation test. Results were evaluated with standard haematological analyses including erythrocyte indices, Hb typing and quantification and polymerase chain reaction (PCR) analysis of alpha-globin and beta-globin genes. FINDINGS: Participants were divided into four groups according to the results of the combined tests. Altogether, 104 of 301 participants (34.6\%) had negative results on both tests; 48 (15.9\%) were positive on the OF test but not the DCIP test; 40 (13.3\%) were negative on the OF test but positive on DCIP test; and 109 (36.2\%) were positive on both tests. No carrier of clinically significant forms of thalassaemia (alpha(o)-thalassaemia, beta-thalassaemia) or Hb E was found among the group that had negative results for both tests. All participants with Hb E had positive DCIP tests. Carriers of alpha+-thalassaemia or Hb Constant Spring could generate either positive or negative OF test results but they all had negative DCIP tests. Using both tests as a preliminary screening for the three important groups of carriers gave a sensitivity of 100\% and a specificity of 69.8\%. The positive predictive value of the combined test was 77.2\%. The negative predictive value was 100\%. Further evaluation of the screening system by local staff at three community hospitals found a sensitivity of 98.1-100\% and a specificity of 65.4-88.4\% with positive predictive values of 75.0-86.9\% and negative predictive values of 98.1-100\%. CONCLUSION: A combined test using OF and DCIP could be used as an effective preliminary screening alternative to an electronic blood cell count for identifying carriers with alpha(o)-thalassaemia, beta-thalassaemia and Hb E. The strategy should prove useful for population screening in prevention and control programmes in rural communities in south-east Asia where laboratory facilities and economic resources are limited.
This article was published in Bull World Health Organ
and referenced in Clinics in Mother and Child Health