Screening for the carriers of thalassemias and abnormal hemoglobins at the community level.

Thalassemia and abnormal hemoglobins are common genetic disorders in Southeast Asia. Thalassemia is not only an important public health problem but also a socio-economic problem of many countries in the region. The approach to deal with the thalassemic problem is to prevent and control births of the new cases. This requires an accurate identification of couple at high risk to have a thalassemic child. The diagnosis of thalassemia carriers need several tests that are not practical for screening the population at large. In this study we used two simple laboratory tests to screen for potential thalassemia carriers and hemoglobin E individuals. Three-hundred pregnant women and 40 spouses were recruited in this study. The methods were the red cell osmotic fragility (OF) screening test with 0.36% NaCl and the dichlorophenolindophenol (DCIP) precipitation test to detect Hb E and unstable hemoglobins. Standard methods for red cell indices, hemoglobin analysis and detection of alpha-thalassemia by immunological method were also performed to confirm genotypes of thalassemia. The results showed that 98 women (32.7%) were carriers of thalassemias and hemoglobin E. The number of false positive by OF test was 3.2% and by DCIP test was 0.6%. Sensitivity and specificity of OF test were 89.5% and 93.3%, respectively whereas those of DCIP test were 100%. Of the 40 couples investigated, one was found to be at risk of having beta-thalassemia/Hb E fetus. Screening techniques including one tube osmotic fragility and DCIP precipitation tests are sensitive and specific for the detection of thalassemia and unstable hemoglobins such as Hb E. The techniques are also simple, economic, rapid, and give minimal false negative result.

Screening health of battary manufacture workers.

Eighty male (32.4 + 7.1 years, 59.3 + 8.9 kg) and 17 females (32.5 + 6.5 years, 56.7 + 11.9 kg) from a battary factory were investigated. From personel history taking and physical examination it was found that the workers showed no signs of physical abnormalities. Laboratory results that were found to be abnormal are as follows (number of cases) : glucose 2, creatinine 1, uric acid 12, triglycerides 14, cholesterol 13, SGOT 2, SGPT 2, y-glutamyl transferase 21, calcium (high) 2, Calcium (low) 25 inorganic phosphate (high) 5, 6, inorganic phosphate (low) 8, ESR 30, haemoglobin (high) 2, haemoglobin (low) 7, haematocrit (high) 5, haematocrit (low) 1, white blood cell count (low) 7, eosinophil 19, monocyte 2, basophillic stippling 8. Abnormality in urinalysis found are : albumin 11, sugar 1, white cell 2, coproporphyrin (+ ve) 23 and ๐-aminolevulinic acid (urine) 30, ๐-aminolevulinic dehydratase (red cell) 16, and hepatitis B antigen positive 7 the results of such investigation can be of help to factory administrators in setting up preventive measure for maintenance of optimal health of workers.