Genetic Hemoglobin Disorders and Anemia in Cambodian Women of Reproductive Age.

Objectives: To examine associations between anemia (Hb <120 g/L) and genetic hemoglobin disorders in Cambodian women (18-45 y). Methods: Blood samples of 450 women from Prey Veng province were analyzed with consent. A complete blood count was performed and the presence and typing of hemoglobin disorders was carried out by PCR and hemoglobin electrophoresis. Serum ferritin, serum transferrin receptor, c-reactive protein and other micronutrients were also assessed. Results: Overall, the prevalence of anemia in women was 33.1%, of which 61% was microcytic (Hb <120 g/L and MCV <80 fl). The prevalence of genetic hemoglobin disorders was > 55% (most commonly alpha-thalassemia, Hb E and Hb Constant Spring) and were significantly correlated with anemia. Of women with anemia, over two-thirds had an abnormal genetic hemoglobin type. Less than 5% of women had a low serum ferritin (< 15 µg/L). Conclusions: The most common form of anemia in Cambodian women is microcytic anemia. Genetic Hb disorders are major contributors to anemia in this region. Low serum ferritin was uncommon suggesting that iron deficiency is not a major problem. However, genetic Hb disorders and concurrent infections may be confounding the interpretation of ferritin and leading to an underestimation of iron-deficiency anemia. Other indicators of iron status and other micronutrients involved in anemia are being examined.

Suboptimal Thiamin Status is Common in Women of Childbearing Age in Rural and Urban Cambodia.

Objectives: Thiamin deficiency causes beriberi, which is often fatal in infants who do not receive rapid treatment. Infantile beriberi appears to be common in Cambodia, likely because thiamin deficient mothers produce breast milk low in thiamin. Strategies may be needed to improve thiamin status; however, population representative thiamin data is required. Therefore, we measured erythrocyte thiamin diphosphate (TDP) concentration to assess thiamin status in Cambodian women of childbearing age. Methods: A representative sample of non-pregnant and non-lactating women of childbearing age (20-45 y) in urban Phnom Penh (n=146) and rural Prey Veng (n=156), and for comparison purposes, a convenience sample of urban women in Vancouver, Canada (n=49) were recruited. TDP was measured using HPLC. Results: The response rates were 91% in Phnom Penh and 98% in Prey Veng. Mean ± SD erythrocyte TDP was 100±38 and 87±26 nmol/L in Phnom Penh and Prey Veng, respectively; which were lower than in Canadian women, [128±38 nmol/L (P<0.001)]. Among Cambodian women, thiamin deficiency (TDP < 70 nmol/L) was more prevalent in Prey Veng (24%) than Phnom Penh (12%). Similarly, insufficient thiamin status (TDP < 90 nmol/L) was more prevalent among women living in Prey Veng (59%) than Phnom Penh (39%). Of Canadian women, 84% were thiamin sufficient (TDP > 90 nmol/L). Conclusions: We found a high prevalence of suboptimal thiamin status in Cambodian women of childbearing age, particularly in rural Prey Veng. Supplementation, fortification, and/or food-based strategies may be required to improve thiamin intake in Cambodian women. Funding: UBC Vitamin Research Fund.