Absence of factor V Arg306--Thr and low factor V Arg306->Gly mutation prevalence in Thai blood donors.

Thrombosis among the Thai population is much lower than in western countries. The Thai population is protected to some extent against familial thrombophilia as by the very low prevalence of factor V Leiden, G20210A prothrombin and C677T methylenetetrahydrofolate reductase mutations. The present study reports the prevalence of two mutations of the factor V gene involving the codon for Arg 306 among 500 healthy adult voluntary blood donors (males 285, females 215) and 30 children (boys 20, girls 10) experiencing a total of 36 thrombotic episodes. The blood donors' ages ranged from 18 to 60 years while the children's ages ranged from 9 months to 15 years. The allelic frequencies of the factor V gene mutation of G1091C and A1090G among blood donors were 0% and 0.4%, respectively. Additionally, both mutations were not present in any of the 30 children with thrombosis. The low prevalence of factor V gene mutations in the codon Arg 306 may be relevant to the low rate of thrombosis among the Thai population.

Cost-effectiveness in establishing hemophilia carrier detection and prenatal diagnosis services in a developing country with limited health resources.

The cost-effectiveness of carrier detection and prenatal diagnosis for hemophilia at the International Hemophilia Training Center, Bangkok, Thailand was studied. From 1991 to 2002, 209 females from 124 families with hemophilia A and B were included. There were 180 hemophilia A carriers and 29 hemophilia B carriers which could be classified into 78 obligate and 131 possible carriers. The phenotypic analysis for possible carriers involved the determination of levels of factor VIII or IX clotting activity (FVIII:C, FIX:C) and the ratio of FVIII:C and von Willebrand factor antigen. The result revealed that 49 females (37.4%) were diagnosed as carriers, 65 females (49.6%) were normal and 17 females (13%) were undetermined. Additional genotypic analysis was provided to 46 families with 74 females with obligate, proven or undetermined carriers within the reproductive life. The polymorphisms associated with factor VIII and IX genes were used including Bcl I for the factor VIII gene and combined use of Mse I, Sal I, Nru I, Hha I and Dde I for the factor IX gene. The informative rate was 59.4% (44/74). Consequently, 12 prenatal diagnoses for fetus at risk were performed. Sex determination was initially determined and followed by the diagnosis of hemophilia through informative gene tracking and/or the measurement of fetal levels of FVIII:C or FIX:C. The result revealed that 3 male fetuses were affected. The total cost of carrier detection and prenatal diagnosis that the families had to pay in the government hospital was 238,600 Baht (US dollars 5,965). It was compared to the estimated cost of minimal replacement therapy using lyophilized cryoprecipitate for the survival time of 30 years in one patient with hemophilia of 1,012,500 Baht (US dollars 25,312.5). The cost of prevention was much less than the replacement therapy. In conclusion, it is cost-effective to establish the service for carrier detection and prenatal diagnosis for hemophilia especially in developing countries with limited health resources.