Screening for thalassemia and hemoglobinopathy in a rural area of Thailand: a preliminary study.

The present study aimed to screen thalassemia and hemoglobinopathy in Baan Na-Ngam, Chachoengsao Province, Thailand. Blood samples were obtained from 266 volunteers; 105 males and 161 females aged 7 to 49 years. Blood samples screened for thalassemia combining the OF and modified DCIP precipitation tests. CBC, RBC indices, hemoglobin typing, HbA2 and Hb E were determined. Combined OF and DCIP tests found that in normal subjects, 128 out of 155 were negative for both, 3 were -/+ pattern, 22 were +/- pattern and 2 was positive for both. Interestingly, one sample showed an abnormal hemoglobin pattern, which could not be determined by automated LPLC. Three beta-thalassemia trait subjects were positive for only the OF test. For the Hb E trait, 57 out of 94 were -/+ pattern; 37 were positive for both tests. Moreover, 14 homozygous Hb E subjects were positive for both tests. The prevalence of beta-thalassemia trait was 1.1%, Hb E trait was 35.3% and homozygous Hb E was 5.3%. Since DNA analysis was not performed, alpha-thalassemia1 and alpha-thalassemia2 traits cannot be excluded. In conclusion, a combination of the OF and DCIP tests is suitable for preliminary screening for thalassemia and hemoglobinopathy. However, RBC parameters, hemoglobin typing and PCR analysis will provide more specific diagnosis, especially in alpha-thalassemias.

Use of the gel test to follow up chimerism in ABO mismatched bone marrow transplantation patient: a case report.

OBJECTIVE: The authors report here our experience using the gel test to follow up chimerism in a 5 year old girl with beta thalassemia/Hemoglobin E disease (beta thal/HbE), post allogeneic bone marrow transplantation with Hb E trait HLA identical sibling donor. They were ABO blood group major mismatched donor-recipient pairs (donor and recipient blood group are B and O, respectively). MATERIAL AND METHOD: Pre and post transplanted EDTA blood samples from the girl with beta thalassemia/ Hemoglobin E were tested for ABO, Rh and direct antiglobulin test (DAT) using the A-B-AB-D-ctl/ AHG card and the titer of anti-A and anti-B were tested by the conventional tube technique. The sex chromosome study and hemoglobin typing were also examined. RESULTS: In this technique, mixed field agglutination is clearly identified from positive and negative results. The authors detected peripheral recovery, mixed O/B population after transplantation on day +26 with positive DAT. The DAT was negative on day +67 after transplantation and the recipient blood group was completely changed to B on day +123. In addition, Hb typing was changed to Hb E trait with Hb F less than 5 % on day +37. The engraftment of neutrophils, more than 5x10(9)/L, was detected on day+14 and platelet count was more than 20x10(9)/L on day +28. On day +90, the patient was transfusion-independent with the mean Hb level at 11.4 g/dL (10.4-13.1). The sex chromosome and hemoglobin typing were changed to the donor on day +300. CONCLUSION: The gel test is an alternative method which is simple and helpful in detecting mixed red blood cell populations, particularly in the ABO or other blood group mismatched bone marrow transplantation.

Laboratory approach in Thai patients with venous thrombosis.

This retrospective study aimed to analyze laboratory findings in Thai patients with venous thrombosis in Phramongkutklao Hospital from August 1997 to October 2004. Blood samples obtained from 166 patients with ages ranging from 10 months to 87 years were tested for protein S (PS), protein C (PC), antithrombin (AT), factor V Leiden (FVL) and prothrombin G20210A. It was found that low levels of PS, PC, and AT were observed in 23 patients (13.9%), 21 patients (12.7%) and 11 patients (6.6%), respectively. The incidence of combined low levels of anticoagulant factors occurred in 23 patients (13.9%). Three patients (1.8%) were positive for FVL. All patients were negative for prothrombin G20210A. Additionally, 85 patients (51.2%) were negative for all tests. In conclusion, it is recommended that the screening tests for anticoagulant factors PS, PC and AT be used to investigate the causes of thrombosis in Asian populations due to their cost-effectiveness. However, the detection of gene mutations inducing thrombosis should be considered.

Dyslipidemia in Thai rural adults.

The present study aimed to determine the prevalence of dyslipidemia in adults in a rural area of Thailand. Random sampling was conducted in 443 volunteers, 187 males and 256 females, aged > or = 35 years in Chachoengsao Province. After a 12-hour fast, the blood was drawn for the analysis of total cholesterol, triglycerides, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol. Mean serum lipids of cholesterol, LDL cholesterol, HDL cholesterol and triglycerides were 207.79 +/- 46.98, 117.26 +/- 36.59, 50.53 +/- 2.14 and 201.21 +/- 131.07 mg/dL, respectively. Nineteen percent of them had cholesterol > or = 240 mg/dL and 10% had LDL cholesterol > or = 160 mg/dL. Seven percent had HDL cholesterol < or = 35 mg/dL. However, LDL/HDL cholesterol ratios > 5, were found in only 0.9%. In conclusion, the prevalence of dyslipidemia was high in rural Thai adults. Further surveillance in this population is essential in verifying the impact of dyslipidemia as a risk of cardiovascular disease in rural Thai adults.

Factor V Leiden and prothrombin G20210A mutations in Thai patients awaiting kidney transplant.

Renal transplantation provides the best long-term treatment for chronic renal failure, but thrombosis of the transplanted renal artery or renal vein is one of the causes of kidney failure in the early postoperative period. Factor V Leiden (FVL) and prothrombin G20210A mutation are the most frequent genetic abnormalities associated with venous thrombosis. We investigated the prevalence of FVL and prothrombin G20210A by polymerase chain reaction with restriction fragment length polymorphism in 75 Thai patients awaiting renal transplant, and a control group of 106 healthy blood donors. Of those awaiting renal transplant, none was found to carry FVL or prothrombin G20210A mutations. Neither the heterozygous nor the homozygous FVL mutation nor the prothrombin G20210A mutation was detected in the 106 healthy volunteers. Although we failed to detect FVL and prothrombin G20210A mutation among those waiting for a kidney transplant, the population size was small. Further studies need to be performed in order to ascertain if these coagulation mutations are of relevance in predicting patients at risk of early transplant failure.

Iron status of one-year-old infants in a well baby clinic.

Seventy-two healthy infants (37 males, 35 females) attending a private well baby clinic were enrolled in the study. Their mean birthweights and body weights at one year of age were 3,079 grams and 10 kilograms, respectively. Blood samples were drawn approximately on their first birthday for evaluating the iron status. Complete blood count, hemoglobin (Hb) typing and DNA analysis for common carrier status of thalassemia and hemoglobinopathis were also determined. According to the infants of serum ferritin, the patients were classified into 4 groups: group 1, iron deficiency anemia (Hb <11 g/dl and ferritin <12 ng/L) in 1 infants (1.4%); group 2, iron deficiency without anemia (Hb >11 g/dl and ferritin <12 ng/L) in 5 infants (6.9%); group 3, borderline iron depletion (ferritin 12-30 ng/L) in 39 infants (54.2%); group 4, iron sufficiency (ferritin >30 ng/L) in 27 infants (37.5%). The iron deficiency state emerged as 8.3 per cent (6/72). There was no significant difference of levels of Hb and mean corpuscular volume (MCV) among the infants with iron deficiency without anemia, borderline iron depletion and iron sufficiency. The results also revealed that 25 out of 72 (34.7%) infants were carriers of thalassemia and hemoglobinopathies. The carrier infants had significant lower Hb and MCV than those of the non-carrier infants with the p-values of 0.004 and 0.000, respectively; while their serum ferritin levels were not significantly different. Additionally, the association of carrier and iron deficiency state was further evaluated. The Hb and MCV among carrier infants with and without iron deficiency were not significantly different. Six infants with carrier state were found to have slightly decreased levels of Hb ranging from 10.3 to 10.9 g/dl with the ferritin ranging from 18.7 to 382.9 ng/L while the remainders had Hb of >11 g/dl. Therefore, 7 out of 72 (9.2%) infants had anemia (Hb <11 g/dl) which was caused by the carrier state of thalassemia and hemoglobinopathies (n=6) and iron deficiency anemia (n=1). The risk factors of iron deficiency status were associated with feeding regimen including continuation of breast feeding until one year of age without adequate haem iron supplement, exclusive formula feeding, inadequacy of solid food supplement with only one meal per day and excluding haem iron from animal liver without substitution. The infants with risk factors had significantly lower levels of serum ferritin (mean 14.1 +/- 1.7 ng/L) than those without risk factors (mean 31.9 +/- 1.9 ng/L) with a p-value of 0.000. In conclusion, adequate haem iron supplement in 3 meals of solid food is essential for the prevention of iron deficiency status in one-year-old infants.