Prenatal Prevention for Severe Thalassemia Disease at Srinagarind Hospital
Thawalwong Ratanasiri MD*, Chutharat Charoenthong MD*, Ratana Komwilaisak MD*, Yotsombat Changtrakul MSc**, Supan Fucharoen DSc***, Jamras Wongkham BSc****, Pilaiwan Kleebkaow MD*, Kanok Seejorn MD*
Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen ** Diagnostic Microscopy Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen *** Center for Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences **** Nursing Division, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen
Objective : To evaluate the results and cost-effectiveness of prenatal prevention measurement in severe thalas-
semia diseases at Srinagarind Hospital.
Study
Design : Descriptive study.
Setting : Antenatal care (ANC) Clinic, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University.
Subjects : 1,498 thalassemic screened pregnant women first presenting at ANC Clinic at gestational age less
than 17 weeks.
Materials and Methods : Medical records of thalassemic screened pregnant women between February 2002 and
February 2005 were analyzed. Those with a value of mean corpuscular volume (MCV) less than 80 fl, or
positive dichlorophenol indophenol precipitation test (KKU-DCIP Clear Reagent Kit) underwent hemoglo-
bin (Hb) typing by high performance liquid chromatography (HPLC) together with thalassemia investigation
(complete blood count, MCV and Hb typing) of their husbands and to identify couples at risk of 3 severe
thalassemia diseases; Hb Bart’s hydrops fetalis, homozygous ‚-thalassemia and ‚-thalassemia/ Hb E disease.
Then they were advised to undergo DNA analysis and, if they had fetal risk, appropriate prenatal diagnosis
was offered
Main outcome measure : Number of affected fetuses detected by prenatal diagnosis.
Results : Nine hundred and ninety six pregnant women (66.49%) were positive on screening. Of these, 642
(64.46%) had thalassemia investigation done with their spouses. There were 19 couples at risk (1.27%of total
screened pregnant women) for having fetal severe thalassemia disease from initial laboratory results. Most of
them were ‚-thalassemia/ Hb E diseases. We found only 10 pregnant women (52.63%) that had undergone
prenatal diagnosis. The consequent results were two affected fetuses (20%), one was Hb Bart’s hydrops fetalis,
and the other was ‚o-thalassemia/ Hb E disease. In these cases, their parents decided to discontinue the
pregnancy. Our prevention program could save 1.14 million bahts for the cost of treatment in two prevented
severe thalassemia cases.
Conclusion : The prenatal prevention program of severe thalassemia disease at Srinagarind Hospital can
effectively detect affected fetuses and reduce severe thalassemia disease, which is a major health problem in
Thailand.
Keywords : Prenatal screening, Prenatal diagnosis, Thalassemia
