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Tenuta M, Cangiano B, Rastrelli G, Carlomagno F, Sciarra F, Sansone A, Isidori AM, Gianfrilli D, Krausz C. Iron overload disorders: Growth and gonadal dysfunction in childhood and adolescence. Pediatr Blood Cancer 2024; 71:e30995. [PMID: 38616355 DOI: 10.1002/pbc.30995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/16/2024]
Abstract
Hemochromatosis (HC) is characterized by the progressive accumulation of iron in the body, resulting in organ damage. Endocrine complications are particularly common, especially when the condition manifests in childhood or adolescence, when HC can adversely affect linear growth or pubertal development, with significant repercussions on quality of life even into adulthood. Therefore, a timely and accurate diagnosis of these disorders is mandatory, but sometimes complex for hematologists without endocrinological support. This is a narrative review focused on puberty and growth disorders during infancy and adolescence aiming to offer guidance for diagnosis, treatment, and proper follow-up. Additionally, it aims to highlight gaps in the existing literature and emphasizes the importance of collaboration among specialists, which is essential in the era of precision medicine.
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Affiliation(s)
- Marta Tenuta
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Biagio Cangiano
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
- Department of Endocrine and Metabolic Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giulia Rastrelli
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | | | - Francesca Sciarra
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Andrea Sansone
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | | | - Csilla Krausz
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
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Brahmantyo M, Savitri M. Challenge in diagnosis of hemoglobin E/beta thalassemia during pregnancy: A case report. Int J Surg Case Rep 2023; 110:108645. [PMID: 37597431 PMCID: PMC10462833 DOI: 10.1016/j.ijscr.2023.108645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/21/2023] Open
Abstract
INTRODUCTION Beta thalassemia (β-thalassemia) in pregnant women increases the risk of obstetric problems such as premature birth and low birth weight, so caution is needed in its management; these cases are usually asymptomatic. PRESENTATION OF CASE A pregnant Indonesian female (gestational age of 36 weeks), 21 years old, complained of general weakness. The patient experienced anemia several times during this pregnancy and received several blood transfusions. Her parents also have β-thalassemia. A physical examination of the patient showed pale conjunctiva and slight icteric sclera. Laboratory examination showed abnormal included hemoglobin (Hb) of 6.7 g/dL, hematocrit of 207 %, mean corpuscular volume (MCV) of 60.1 fL, mean corpuscular hemoglobin (MCH) of 19.3 pg, mean corpuscular hemoglobin concentration (MCHC) of 32.1 g/dL, albumin of 3.06 g/dL, direct bilirubin of 0.75 mg/dL, and total bilirubin of 1.78 mg/dL. Peripheral blood smear examination showed β-thalassemia. She received a high-calorie and protein diet with extra eggwhite of 2100 kcal/day, leukodepleted packed red blood cell (LD-PRBC) transfusion of 2 × 250 cc/day, folic acid of 3 × 1 mg/day, and methylprednisolone of 3 × 62.5 mg/day. The patient gave birth to a baby girl spontaneously. She received methylprednisolone of 3 × 16 mg with tapering off every week and folic acid of 3 × 1 mg. The patient's prognosis showed improvement. DISCUSSION Pregnancy weakens the immune system; therefore β-thalassemia is frequently discovered during this time, and keeping the mother's Hb ≥10 g/dL prevents complications. CONCLUSION Maintaining Hb ≥10 g/dL minimizes complications for mother and baby.
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Affiliation(s)
- Median Brahmantyo
- Department of Internal Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo, General Academic Hospital, Surabaya, Indonesia
| | - Merlyna Savitri
- Department of Internal Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo, General Academic Hospital, Surabaya, Indonesia.
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Sayani FA, Singer ST, Carlberg KT, Vichinsky EP. Fertility and Pregnancy in Women with Transfusion-Dependent Thalassemia. Hematol Oncol Clin North Am 2023; 37:393-411. [PMID: 36907611 DOI: 10.1016/j.hoc.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Because women with transfusion-dependent thalassemia are seeking pregnancy, ensuring the best outcomes for both mother and baby require concerted and collaborative efforts between the hematologist, obstetrician, cardiologist, hepatologist, and genetic counselor among others. Proactive counseling, early fertility evaluation, optimal management of iron overload and organ function, and application of advances in reproductive technology and prenatal screening are important in ensuring a healthy outcome. Many unanswered questions remain requiring further study, including fertility preservation, non-invasive prenatal diagnosis, chelation therapy during pregnancy, and indications and duration of anticoagulation.
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Affiliation(s)
- Farzana A Sayani
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Sylvia T Singer
- Division of Hematology/Oncology, UCSF Benioff Children's Hospital, 747 52nd Street, Oakland, CA 94609, USA
| | - Katie T Carlberg
- Division of Cancer and Blood Disorders, University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Elliott P Vichinsky
- Division of Hematology/Oncology, UCSF Benioff Children's Hospital, 747 52nd Street, Oakland, CA 94609, USA
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Pines M, Sheth S. Clinical Classification, Screening, and Diagnosis in Beta-Thalassemia and Hemoglobin E/Beta-Thalassemia. Hematol Oncol Clin North Am 2023; 37:313-325. [PMID: 36907605 DOI: 10.1016/j.hoc.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
This article reviews the classification of beta-thalassemia syndromes, correlating clinical severity and genotype in the earlier classification, and broadening it recently based on clinical severity and transfusion status. The classification is dynamic, and individuals may progress from transfusion-independent to transfusion-dependent. Early and accurate diagnosis prevents delays in instituting treatment and comprehensive care, and precludes inappropriate and potentially harmful interventions. Screening can inform risk in an individual and subsequent generations when partners may be carriers as well. This article discusses the rationale for screening of the at-risk population. In the developed world, a more precise genetic diagnosis must be considered.
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Affiliation(s)
- Morgan Pines
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Weill Cornell Medicine, P-695, 525 East 68th Street, New York, NY 10065, USA; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, H1117A, New York, NY 10065, USA
| | - Sujit Sheth
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Weill Cornell Medicine, P-695, 525 East 68th Street, New York, NY 10065, USA.
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Lagadinou M, Markantes G, Amerali M, Mulita F, Marangos M, Michalaki M. A Retrospective Study of Various Iron Preparations Oral Administration in Pregnant Women with Iron Deficiency Anemia. Mater Sociomed 2023; 35:157-164. [PMID: 37701349 PMCID: PMC10495134 DOI: 10.5455/msm.2023.35.157-164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/06/2023] [Indexed: 09/14/2023] Open
Abstract
During pregnancy anemia is a common medical condition, with iron deficiency and megaloblastic anemia being the most common. The symptoms range from very mild to severe and if left without proper medical treatment, there can be serious consequences for both mother and fetus. The most frequent pregnancy problem is anemia. The term "Iron Deficiency Anemia" refers to erythropoiesis under conditions of absolute iron deficiency. This presupposes the depletion of iron stores in the body. Iron deficiency anemia or Sideropenic anemia is the most common form of anemia worldwide. Special attention must be given to nutrition during pregnancy. In the current retrospective study, it was evaluated the contribution of various iron preparations substitution during the pregnancy and puerperium.
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Affiliation(s)
- Maria Lagadinou
- Department of Internal medicine, University Hospital of
Patras, Patras Greece
| | - Georgios Markantes
- Division of Endocrinology, University Hospital of Patras,
Patras, Greece
| | - Marina Amerali
- Department of Internal medicine, University Hospital of
Patras, Patras Greece
| | - Francesk Mulita
- Department of General Surgery, University Hospital of
Patras, Patras, Greece
| | - Markos Marangos
- Department of Internal medicine, University Hospital of
Patras, Patras Greece
| | - Marina Michalaki
- Division of Endocrinology, University Hospital of Patras,
Patras, Greece
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6
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Zhou Y, Ding YL, Zhang LJ, Peng M, Huang J. Direct antiglobulin test-negative autoimmune hemolytic anemia in a patient with β-thalassemia minor during pregnancy: A case report. World J Clin Cases 2022; 10:1388-1393. [PMID: 35211574 PMCID: PMC8855192 DOI: 10.12998/wjcc.v10.i4.1388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/27/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe refractory anemia during pregnancy can cause serious maternal and fetal complications. If the cause cannot be identified in time and accurately, blind symptomatic support treatment may cause serious economic burden. Thalassemia minor pregnancy is commonly considered uneventful, and the condition of anemia rarely progresses during pregnancy. Autoimmune hemolytic anemia (AIHA) is rare during pregnancy with no exact incidence available.
CASE SUMMARY We report the case of a 30-year-old β-thalassemia minor multiparous patient experiencing severe refractory anemia throughout pregnancy. We monitored the patient closely, carried out a full differential diagnosis, made a diagnosis of direct antiglobulin test-negative AIHA, and treated her with prednisone and intravenous immunoglobulin. The patient gave birth to a healthy full-term baby.
CONCLUSION Coombs-negative AIHA should be suspected in cases of severe hemolytic anemia in pregnant patients with and without other hematological diseases.
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Affiliation(s)
- Yang Zhou
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Yi-Ling Ding
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Li-Juan Zhang
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Mei Peng
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Jian Huang
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
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Virot E, Thuret I, Jardel S, Herbrecht R, Lachenal F, Lionnet F, Lucchini MJ, Machin J, Nimubona S, Ribeil JA, Galacteros F, Cannas G, Hot A. Pregnancy outcome in women with transfused beta-thalassemia in France. Ann Hematol 2021; 101:289-296. [PMID: 34668980 DOI: 10.1007/s00277-021-04697-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/10/2021] [Indexed: 01/19/2023]
Abstract
Because of chronic anemia, hypogonadotropic hypogonadism, and iron chelation, pregnancy in homozygous and heterozygous compound beta-thalassemia patients stays a challenge. Pregnancies of transfused beta-thalassemia women registered in the French National Registry, conducted between 1995 and 2015, are described. These pregnancies were compared with pregnancies in healthy women and to data previously published in the literature. Fifty-six pregnancies of 37 women were studied. There were 5 twin pregnancies. Assisted reproductive technologies (ART) were used in 9 pregnancies. Median term at delivery was 39 amenorrhea weeks, and median weight at birth was 2780 g. Cesarean section was performed in 53.6% of the pregnancies. There were 6 thromboembolic events, 6 serious infections, 6 pregnancy-induced hypertensions (PIH), 6 intrauterine growth retardations (IUGR), 5 severe hemorrhages, 4 gestational diabetes, 3 alloimmunizations, 2 heart diseases, and 1 pre-eclampsia. There were 5 infections and 4 osteoporosis in the first year of post-partum. ART and cesarean sections were more often used in the beta-thalassemia group, compared to control subjects. Thromboembolic events, PIH, hemorrhage at delivery, and IUGR were more frequent in the beta-thalassemia group. Time to delivery was not different, but infant weight at birth was significantly smaller in the beta-thalassemia group. In the post-partum period, global maternal complications were more frequent in the beta-thalassemia group. Pregnancy in transfused beta-thalassemia women is safe with rare obstetrical and fetal complications. Cesarean section remains often chosen, and infant weight at birth remains smaller than that in the general population, despite delivery at full term.
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Affiliation(s)
- Emilie Virot
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval 69003, Lyon, France.
| | - Isabelle Thuret
- Département d'Hématologie Pédiatrique, Centre de Référence Français Des Thalassémies, Hôpital de La Timone, Marseille, France
| | - Sabine Jardel
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval 69003, Lyon, France
| | - Raoul Herbrecht
- Département d'Onco-Hématologie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | - Florence Lachenal
- Département d'Hématologie, Hôpital de Bourgoin-Jallieu, Bourgoin-Jallieu, France
| | | | - Marie-José Lucchini
- Département de Médecine Interne, Centre Hospitalier d'Ajaccio, Ajaccio, France
| | - Julie Machin
- Département d'Hématologie, Centre Hospitalier de Roubaix, Roubaix, France
| | - Stanislas Nimubona
- Dépatement d'Hématologie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | | | | | - Giovanna Cannas
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval 69003, Lyon, France
| | - Arnaud Hot
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval 69003, Lyon, France
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8
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Faber R, Heling KS, Steiner H, Gembruch U. Doppler ultrasound in pregnancy - quality requirements of DEGUM and clinical application (part 2). ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:541-550. [PMID: 33906258 DOI: 10.1055/a-1452-9898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This second part on Doppler sonography in prenatal medicine and obstetrics reviews its clinical applications. While this has not become the initially anticipated screening tool, it is used for the diagnosis and surveillance of a variety of fetal pathologies. For example, the sonography-based determination of uterine artery blood flow indices is an important parameter for the first trimester multimodal preeclampsia risk assessment, increasing accuracy and providing indication for the prophylactic treatment with aspirin. It also has significant implications for the diagnosis and surveillance of growth-restricted fetuses in the second and third trimesters through Doppler-sonographic analysis of umbilical artery, middle cerebral artery and ductus venosus. Here, especially the hemodynamics of the ductus venosus provides a critical criterium for birth management of severe, early-onset FGR before 34 + 0 weeks of gestation. Further, determination of maximum blood flow velocity of the middle cerebral artery is a central parameter in fetal diagnosis of anemia which has been significantly improved by this analysis. However, it is important to note that the mentioned improvements can only be achieved through highest methodological quality. Importantly, all these analyses are also applied to twins and higher order multiples. Here, for the differential diagnosis of specific complications such as TTTS, TAPS and TRAP, the application of Doppler sonography has become indispensable. To conclude, the successful application of Doppler sonography requires both exact methodology and precise pathophysiological interpretation of the data.
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Affiliation(s)
- Renaldo Faber
- Leipzig, Center of Prenatal Medicine, Leipzig, Germany
| | - Kai-Sven Heling
- Praxis, prenetal diagnosis and human genetics, Berlin, Germany
| | | | - Ulrich Gembruch
- Obstetrics and Prenatal Medicine, University Hospital, Bonn, Germany
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Shafique F, Ali S, Almansouri T, Van Eeden F, Shafi N, Khalid M, Khawaja S, Andleeb S, Hassan MU. Thalassemia, a human blood disorder. BRAZ J BIOL 2021; 83:e246062. [PMID: 34495151 DOI: 10.1590/1519-6984.246062] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/02/2021] [Indexed: 11/22/2022] Open
Abstract
A group of inherited blood defects is known as Thalassemia is among the world's most prevalent hemoglobinopathies. Thalassemias are of two types such as Alpha and Beta Thalassemia. The cause of these defects is gene mutations leading to low levels and/or malfunctioning α and β globin proteins, respectively. In some cases, one of these proteins may be completely absent. α and β globin chains form a globin fold or pocket for heme (Fe++) attachment to carry oxygen. Genes for alpha and beta-globin proteins are present in the form of a cluster on chromosome 16 and 11, respectively. Different globin genes are used at different stages in the life course. During embryonic and fetal developmental stages, γ globin proteins partner with α globin and are later replaced by β globin protein. Globin chain imbalances result in hemolysis and impede erythropoiesis. Individuals showing mild symptoms include carriers of alpha thalassemia or the people bearing alpha or beta-thalassemia trait. Alpha thalassemia causes conditions like hemolytic anemia or fatal hydrops fetalis depending upon the severity of the disease. Beta thalassemia major results in hemolytic anemia, growth retardation, and skeletal aberrations in early childhood. Children affected by this disorder need regular blood transfusions throughout their lives. Patients that depend on blood transfusion usually develop iron overload that causes other complications in the body systems like renal or hepatic impairment therefore, thalassemias are now categorized as a syndrome. The only cure for Thalassemias would be a bone marrow transplant, or gene therapy with currently no significant success rate. A thorough understanding of the molecular basis of this syndrome may provide novel insights and ideas for its treatment, as scientists have still been unable to find a permanent cure for this deadly disease after more than 87 years since it is first described in 1925.
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Affiliation(s)
- F Shafique
- University of Azad Jammu and Kashmir, Faculty of Science, Department of Zoology, Muzaffarabad, Pakistan.,University of Sheffield, Faculty of Science, Department of Biomedical Science, Sheffield, United Kingdom
| | - S Ali
- Government College University Lahore, Faculty of Science, Department of Zoology, Applied Entomology and Medical Toxicology Laboratory, Lahore, Pakistan
| | - T Almansouri
- University of Sheffield, Sheffield Institute for Translational Neuroscience - SITraN, Department of Neuroscience, Sheffield, United Kingdom.,King Abdulaziz University, Department of Applied Medical Science (Medical Laboratory), Jeddah, Saudi Arabia
| | - F Van Eeden
- University of Sheffield, Faculty of Science, Department of Biomedical Science, Sheffield, United Kingdom
| | - N Shafi
- University of Azad Jammu and Kashmir, Faculty of Science, Department of Zoology, Muzaffarabad, Pakistan
| | - M Khalid
- Women University of Azad Kashmir, Department of Biotechnology, Bagh, Azad Kashmir, Pakistan
| | - S Khawaja
- University of Azad Jammu and Kashmir, Department of Biotechnology, Muzaffarabad, Pakistan
| | - S Andleeb
- University of Azad Jammu and Kashmir, Faculty of Science, Department of Zoology, Muzaffarabad, Pakistan
| | - M Ul Hassan
- University of Sheffield, Faculty of Science, Department of Molecular Biology and Biotechnology, Sheffield, United Kingdom
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Adler A, Wainstock T, Sheiner E. Prenatal exposure to maternal β-thalassemia minor and the risk for long-term hematologic morbidity in the offspring: A population-based cohort study. Early Hum Dev 2021; 158:105397. [PMID: 34102479 DOI: 10.1016/j.earlhumdev.2021.105397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 04/18/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE β-Thalassemia has been shown to be associated with adverse short-term perinatal outcomes including low birth weight and preterm labor. The aim of this study was to assess whether in-utero exposure of maternal β-thalassemia minor is a risk factor for offspring hematological morbidity. STUDY DESIGN A population-based retrospective cohort study was conducted, including all infants born between the years 1991-2014 at a tertiary medical center. Long-term hospitalizations with hematologic morbidities were compared between offspring of mothers with or without β-thalassemia minor. Multiple gestations, perinatal mortality, chromosomal disorders and congenital malformations were excluded. Both study groups were followed until 18 years of age for hospitalization with hematological morbidities. Kaplan-Meier survival curve was used to compare the cumulative hematological morbidity incidence between both groups, and a Cox proportional hazard model was used to control for confounders. RESULTS During the study period, 243,682 deliveries met the inclusion criteria, of them 0.3% (n = 677) were of mothers with β-thalassemia minor. Among offspring to thalassemic versus non-thalassemic mothers, hospitalization rates involving hematological morbidity, were higher (3.3% vs. 0.7%, p < 0.001) a finding that was consistent with the Kaplan-Meier survival curve (log rank p < 0.001). Using Cox regression model, which adjusted for maternal age, SGA, gestational age and birth weight, maternal β-thalassemia minor was found to be an independent risk factor for long-term offspring hematological (aHR = 5.54; 95% CI 3.63-8.44, p < 0.001, 5.56; 95% CI 3.65-8.47, p < 0.001, and 5.49; 95% CI 3.60-8.36, p < 0.001, respectively). CONCLUSION Prenatal maternal β-thalassemia minor is independently associated with offspring long-term hematological morbidity.
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Affiliation(s)
- Anoushka Adler
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Baldwin HJ, Nippita TA, Torvaldsen S, McGee TM, Rickard K, Patterson JA. Validation of anaemia, haemorrhage and blood disorder reporting in hospital data in New South Wales, Australia. BMC Res Notes 2021; 14:167. [PMID: 33947454 PMCID: PMC8094525 DOI: 10.1186/s13104-021-05584-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/23/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Hospital data are a useful resource for studying pregnancy complications, including bleeding-related conditions, however, the reliability of these data is unclear. This study aims to examine reliability of reporting of bleeding-related conditions, including anaemia, obstetric haemorrhage and blood disorders, and procedures, such as blood transfusion and hysterectomy, in coded hospital records compared with obstetric data from two large tertiary hospitals in New South Wales. RESULTS There were 36,051 births between 2011 and 2015 included in the analysis. Anaemia and blood disorders were poorly reported in the hospital data, with sensitivity ranging from 2.5% to 24.8% (positive predictive value (PPV) 12.0-82.6%). Reporting of postpartum haemorrhage, transfusion and hysterectomy showed high sensitivity (82.8-96.0%, PPV 78.0-89.6%) while moderate consistency with the obstetric data was observed for other types of obstetric haemorrhage (sensitivity: 41.9-65.1%, PPV: 50.0-56.8%) and placental complications (sensitivity: 68.2-81.3%, PPV: 20.3-72.3%). Our findings suggest that hospital data may be a reliable source of information on postpartum haemorrhage, transfusion and hysterectomy. However, they highlight the need for caution for studies of anaemia and blood disorders, given high rates of uncoded and 'false' cases, and suggest that other sources of data should be sought where possible.
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Affiliation(s)
- Heather J. Baldwin
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
| | - Tanya A. Nippita
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, NSW Australia
| | - Siranda Torvaldsen
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
- School of Public Health and Community Medicine, UNSW, Sydney, NSW Australia
| | - Therese M. McGee
- OG Department, Clinical Support Unit, Level 3, G Block, Westmead Hospital, Westmead, NSW Australia
- The University of Sydney Westmead Clinical School, Westmead, NSW Australia
| | - Kristen Rickard
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, NSW Australia
| | - Jillian A. Patterson
- The University of Sydney Northern Clinical School, Women and Babies Research, C/O University Department of O&G, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW Australia
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12
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Ghosh MD, Datta MR, Singh V, Rana F. Pregnancy and Childbirth: An Unexpected Cakewalk for a Mother With Beta Thalassemia Major Homozygous for IVS (G-C) Mutation. Cureus 2021; 13:e13872. [PMID: 33868836 PMCID: PMC8043053 DOI: 10.7759/cureus.13872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The thalassemias are the most common single-gene disorders of hemoglobin synthesis. The salient features of beta thalassemia major, in which both alleles of the HBB gene are affected, are transfusion dependency and iron overload. Although with advances in treatment, the life expectancy in such patients has increased, they have difficulty in conceiving. We report a case of pregnancy in a beta thalassemia major patient who was transfusion independent and had no iron overload. Genetic analysis revealed IVS 1-5 (G-C) mutation in the homozygous state which usually manifests in severe disease and blood transfusion dependency. On the contrary, she did not need blood transfusion, had a smooth antenatal period and a vaginal delivery at term with a favorable childbirth experience. This case report highlights complex genetic interplay and the role of fetal hemoglobin (HbF) enhancer loci which modulates HbF levels thereby raising total hemoglobin levels.
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Affiliation(s)
- Mousumi D Ghosh
- Department of Obstetrics and Gynaecology, Tata Main Hospital, Jamshedpur, IND
| | - Mamta R Datta
- Department of Obstetrics and Gynaecology, Tata Main Hospital, Jamshedpur, IND
| | - Vinita Singh
- Department of Obstetrics and Gynaecology, Tata Main Hospital, Jamshedpur, IND
| | - Farah Rana
- Department of Pathology, Tata Main Hospital, Jamshedpur, IND
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Abstract
Rare inherited anemias are a subset of anemias caused by a genetic defect along one of the several stages of erythropoiesis or in different cellular components that affect red blood cell integrity, and thus its lifespan. Due to their low prevalence, several complications on growth and development, and multi-organ system damage are not yet well defined. Moreover, during the last decade there has been a lack of proper understanding of the impact of rare anemias on maternal and fetal outcomes. In addition, there are no clear-cut guidelines outlining the pathophysiological trends and management options unique to this special population. Here, we present on behalf of the European Hematology Association, evidence- and consensus-based guidelines, established by an international group of experts in different fields, including hematologists, gynecologists, general practitioners, medical geneticists, and experts in rare inherited anemias from various European countries for standardized and appropriate choice of therapeutic interventions for the management of pregnancy in rare inherited anemias, including Diamond-Blackfan Anemia, Congenital Dyserythropoietic Anemias, Thalassemia, Sickle Cell Disease, Enzyme deficiency and Red cell membrane disorders.
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14
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Sorrentino F, Maffei L, Caprari P, Cassetta R, Dell'Anna D, Materazzi S, Risoluti R. Pregnancy in Thalassemia and Sickle Cell Disease: The Experience of an Italian Thalassemia Center. Front Mol Biosci 2020; 7:16. [PMID: 32118041 PMCID: PMC7033579 DOI: 10.3389/fmolb.2020.00016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/28/2020] [Indexed: 12/16/2022] Open
Abstract
The life expectancy of thalassemia patients has increased significantly in recent years being the most "elderly" patients approaching or are over 50 years old. Consequently, patients' perspectives have changed, leading them to longer-term planning with a consequent increase in their reproductive potential and desire to have children. Crucial points in the management of pregnancy in thalassemia are the iron chelation therapy before and during pregnancy, the antithrombotic prophylaxis, the management of transfusion therapy according to the modified transfusion requirement, a cardiologic monitoring for hemodynamic changes that expose an increased risk of heart failure. Pregnancy in women with sickle cell disease is still associated with increased rates of maternal and fetal mortality and adverse outcomes. Maternal morbidity may be due to acute sickling crises, thromboembolism, infection, and chronic end-organ dysfunction, while neonatal outcomes may be intrauterine growth retardation, preterm delivery, small infants for gestational age, stillbirth, and neonatal death. The management of pregnancy in thalassemia and sickle cell disease requires to be approached by a multidisciplinary team and followed from the pre-conception phase until the post-partum period with a close monitoring of the maternal and fetal conditions, in order to ensure optimal outcome. This approach requires the application of well-defined protocols that cover all the critical aspects of pregnancies in women affected by these pathologies. We describe our experience of spontaneous and non-spontaneous pregnancies in patients with thalassemia major and intermedia and sickle cell disease followed between 1992 and 2018 at the Thalassemia Unit of S. Eugenio Hospital of Rome.
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Affiliation(s)
| | - Laura Maffei
- Thalassemia Unit, S. Eugenio Hospital, Rome, Italy
| | - Patrizia Caprari
- National Centre for the Control and Evaluation of Medicines, Istituto Superiore di Sanità, Rome, Italy
| | | | | | | | - Roberta Risoluti
- Department of Chemistry, Sapienza University of Rome, Rome, Italy
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15
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Nourollahpour Shiadeh M, Cassinerio E, Modarres M, Zareiyan A, Hamzehgardeshi Z, Behboodi Moghadam Z. Reproductive health issues in female patients with beta-thalassaemia major: a narrative literature review. J OBSTET GYNAECOL 2020; 40:902-911. [PMID: 31999213 DOI: 10.1080/01443615.2019.1692802] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
β-thalassaemia major (BTM) has a high prevalence worldwide and is associated with considerable morbidity and mortality. The aim of this review is to provide an illustrative overview of the reproductive health and pregnancy related issues in females with β-thalassaemia. A literature search was performed in four international databases (1980-2018) to identify the potentially relevant articles. Common reproductive health disorders are hypo-gonadotrophic hypogonadism, infertility, delayed or absent sexual development, diabetes, hypothyroidism, hypoparathyroidism, osteopenia, preeclampsia, gestational hypertension, polyhydramnios, oligohydramnios, thrombosis, renal failure, peripheral vascular resistance, placenta previa, pleural effusion and pulmonary hypertension. Many of those aspects are related to iron overload and to ineffective erythropoiesis. Foetal complications include neural tube defects, abnormalities in different organs, spontaneous abortion, foetal loss, preterm birth, foetal growth restriction and low birth weight. Antenatal screening and accurate genetic prenatal examinations are effective measures to early diagnosis of thalassaemia and a detailed plan for management of pregnancies in BTM is important for favourable maternal and foetal outcome.
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Affiliation(s)
- Malihe Nourollahpour Shiadeh
- Department of Midwifery and Reproductive Health, Nursing and Midwifery School, Tehran University of Medical Sciences, Tehran, Iran
| | - Elena Cassinerio
- Department of Internal Medicine, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maryam Modarres
- Department of Midwifery and Reproductive Health, Nursing and Midwifery School, Tehran University of Medical Sciences, Tehran, Iran
| | - Armin Zareiyan
- Department of Community Health Nursing, Faculty of Nursing, Aja University of Medical Sciences, Tehran, Iran
| | - Zeinab Hamzehgardeshi
- Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Behboodi Moghadam
- Department of Midwifery and Reproductive Health, Nursing and Midwifery School, Tehran University of Medical Sciences, Tehran, Iran
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16
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Kroll ME, Kurinczuk JJ, Hollowell J, Macfarlane A, Li Y, Quigley MA. Ethnic and socioeconomic variation in cause-specific preterm infant mortality by gestational age at birth: national cohort study. Arch Dis Child Fetal Neonatal Ed 2020; 105:56-63. [PMID: 31123058 PMCID: PMC6951229 DOI: 10.1136/archdischild-2018-316463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/08/2019] [Accepted: 04/12/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To describe ethnic and socioeconomic variation in cause-specific infant mortality of preterm babies by gestational age at birth. DESIGN National birth cohort study. SETTING England and Wales 2006-2012. SUBJECTS Singleton live births at 24-36 completed weeks' gestation (n=256 142). OUTCOME MEASURES Adjusted rate ratios for death in infancy by cause (three groups), within categories of gestational age at birth (24-27, 28-31, 32-36 weeks), by baby's ethnicity (nine groups) or area deprivation score (Index of Multiple Deprivation quintiles). RESULTS Among 24-27 week births (5% of subjects; 47% of those who died in infancy), all minority ethnic groups had lower risk of immaturity-related death than White British, the lowest rate ratios being 0.63 (95% CI 0.49 to 0.80) for Black Caribbean, 0.74 (0.64 to 0.85) for Black African and 0.75 (0.60 to 0.94) for Indian. Among 32-36 week births, all minority groups had higher risk of death from congenital anomalies than White British, the highest rate ratios being 4.50 (3.78 to 5.37) for Pakistani, 2.89 (2.10 to 3.97) for Bangladeshi and 2.06 (1.59 to 2.68) for Black African; risks of death from congenital anomalies and combined rarer causes (infection, intrapartum conditions, SIDS and unclassified) increased with deprivation, the rate ratios comparing the most with the least deprived quintile being, respectively, 1.54 (1.22 to 1.93) and 2.05 (1.55 to 2.72). There was no evidence of socioeconomic variation in deaths from immaturity-related conditions. CONCLUSIONS Gestation-specific preterm infant mortality shows contrasting ethnic patterns of death from immaturity-related conditions in extremely-preterm babies, and congenital anomalies in moderate/late-preterm babies. Socioeconomic variation derives from congenital anomalies and rarer causes in moderate/late-preterm babies. Future research should examine biological origins of extremely preterm birth.
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Affiliation(s)
- Mary E Kroll
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer J Kurinczuk
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer Hollowell
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alison Macfarlane
- Department of Midwifery, School of Health Sciences, City University, London, UK
| | - Yangmei Li
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A Quigley
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Akıncı B, Yaşar AŞ, Özdemir Karadaş N, Önder Siviş Z, Hekimci Özdemir H, Yılmaz Karapınar D, Balkan C, Kavaklı K, Aydınok Y. Fertility in Patients with Thalassemia and Outcome of Pregnancies: A Turkish Experience. Turk J Haematol 2019; 36:274-277. [PMID: 31198015 PMCID: PMC6863022 DOI: 10.4274/tjh.galenos.2019.2019.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objective: In recent years, the rates of marriage and pregnancy are increasing in patients with thalassemia major. The aim of the present study was to investigate the fertility rate of thalassemic patients and the course of pregnancies in terms of mother and infant health. Materials and Methods: In this observational study patients with major hemoglobinopathy were evaluated regarding marital status, the need for assisted reproductive techniques, fertility rate, iron status, and pregnancy complications. Results: Seventeen female patients gave birth to 21 healthy infants. About one-third of the patients needed assisted reproductive techniques. Thalassemia major patients showed increased serum ferritin levels from 1203±1206 μg/L at baseline to 1880±1174 μg/L at the end of pregnancy. All babies are still alive and healthy. Conclusion: Pregnancy in patients with thalassemia can be safe for the mother and newborn with close monitoring and a multidisciplinary approach.
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Affiliation(s)
- Burcu Akıncı
- Ege University Faculty of Medicine, Department of Pediatric Hematology, Thalassemia Center, İzmir, Turkey
| | - Akkız Şahin Yaşar
- Ege University Faculty of Medicine, Department of Pediatric Hematology, Thalassemia Center, İzmir, Turkey
| | - Nihal Özdemir Karadaş
- Ege University Faculty of Medicine, Department of Pediatric Hematology, Thalassemia Center, İzmir, Turkey
| | - Zuhal Önder Siviş
- Ege University Faculty of Medicine, Department of Pediatric Hematology, Thalassemia Center, İzmir, Turkey
| | - Hamiyet Hekimci Özdemir
- Ege University Faculty of Medicine, Department of Pediatric Hematology, Thalassemia Center, İzmir, Turkey
| | - Deniz Yılmaz Karapınar
- Ege University Faculty of Medicine, Department of Pediatric Hematology, Thalassemia Center, İzmir, Turkey
| | - Can Balkan
- Ege University Faculty of Medicine, Department of Pediatric Hematology, Thalassemia Center, İzmir, Turkey
| | - Kaan Kavaklı
- Ege University Faculty of Medicine, Department of Pediatric Hematology, Thalassemia Center, İzmir, Turkey
| | - Yeşim Aydınok
- Ege University Faculty of Medicine, Department of Pediatric Hematology, Thalassemia Center, İzmir, Turkey
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18
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Li Y, Zhang Z, Yang L, Li X, Zhou J, Li D, Luo S. Colla corii asini might upregulate ZNF471 and THOC5 by KRAB domain-containing zinc-finger protein pathway and THO complex subunit 5 pathway to improve anemia of pregnant women with β-thalassemia. Ann Hematol 2019; 98:1813-1826. [PMID: 31098739 DOI: 10.1007/s00277-019-03710-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/05/2019] [Indexed: 12/25/2022]
Abstract
Pregnant patients with β-thalassemia are more likely to have progressive anemia which expose them to risk of adverse pregnancy outcomes, blood transfusion, and iron overload. Results from our previous study indicated that Colla corii asini (CCA, E'jiao), a natural ingredient of traditional Chinese medicine, could significantly increase hemoglobin level of pregnant women with β- thalassemia, but the underlying molecular mechanism was unclear. Thus, we applied high-throughput transcriptome sequencing to study the transcriptomic change before and after the CCA treatment. Twenty eligible pregnant women were recruited and randomized to either the CCA treatment group or the blank control group in a 3:1 ratio. Patients in the treatment group orally received daily 15 g CCA powder for 4 weeks. We analyzed the therapeutic effect indexes and the transcriptomic change in subjects' peripheral blood before and after treatment. We found that β CD 41-42(-TTCT)/βA was the main genotype of the subjects. The regulatory impact of CCA treatment became more evident among the subjects of genotype β CD 41-42(-TTCT)/βA. Gene ontogenesis analysis revealed that the top five molecular functions of differentially expressed genes were involved in membrane functionality and cellular structure. We further identified two consistent upregulated genes ZNF471 and THOC5 in the effective treatment group, which were engaged in Kruppel-associated box (KRAB) domain-containing zinc-finger protein pathway and THOC5 pathway, respectively. Based on our current findings, we hypothesize that the anti-anemia effect of CCA on pregnant women with β-thalassemia might be related to translation regulation of spectrin synthesis, membrane stability, and eventually prolonged the life span of erythrocytes.
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Affiliation(s)
- Yanfang Li
- Department of Obstetrics, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhanfeng Zhang
- Department of Clinical Laboratory, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lilin Yang
- Department of Gynecology, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiangyi Li
- Department of Obstetrics, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jingwen Zhou
- Department of Obstetrics, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Daocheng Li
- Department of Obstetrics, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Songping Luo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, No.12 Jichang Road, Guangzhou, 510405, Guangdong, China.
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19
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Abstract
As more women with transfusion-dependent thalassemia are seeking pregnancy, ensuring the best outcomes for both the mother and baby requires concerted, collaborative efforts between practitioners and the family. Proactive counseling, early fertility evaluation, recent developments in reproductive technology, and optimal management of iron overload, have resulted in more successful pregnancies and the birth of healthy newborns. With advances in technology for prenatal screening and increased awareness to perform screening for hemoglobinopathies, healthy pregnancy outcomes have become the expectation. Topics that require further study include management that allows fertility preservation, improved non-invasive prenatal diagnosis methods for affected fetuses, the use of chelation therapy during pregnancy, and indications for and duration of anticoagulation.
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20
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Chan YM, Chan OK, Cheng YKY, Leung TY, Lao TTH, Sahota DS. Acceptance towards giving birth to a child with beta-thalassemia major - A prospective study. Taiwan J Obstet Gynecol 2017; 56:618-621. [PMID: 29037546 DOI: 10.1016/j.tjog.2017.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To explore the acceptance of pregnant Chinese women on giving birth to a child with beta-thalassemia major. MATERIALS AND METHODS Women's acceptance on having a child with beta thalassemia major was assessed using standard gamble metrics during an interviewer-administered survey on 309 women recruited in the antenatal clinic. Utility scores were determined and the association with sociodemographic factors was assessed. RESULTS The median utility score for having a child with beta-thalassemia major was 0.5 (0-0.65). Women having either higher educational level or family income had significantly higher utility scores (P < 0.05) corresponding to a higher acceptance. During the interview 59.9% participants indicated that they would elect to undergo a termination of pregnancy if their fetus was diagnosed with beta-thalassemia major but 26.5% participants were unable to decide what action they would take. CONCLUSION Many Chinese pregnant women are ambivalent about giving birth to a baby with beta-thalassemia major. Women with higher educational level or higher family income had a higher acceptance towards the condition.
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Affiliation(s)
- Yiu Man Chan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Oi Ka Chan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Yvonne Kwun Yue Cheng
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Tak Yeung Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Terence Tzu Hsi Lao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Daljit Singh Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
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21
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Benli AR, Yildiz SS, Cikrikcioglu MA. An evaluation of thyroid autoimmunity in patients with beta thalassemia minor: A case-control study. Pak J Med Sci 2017; 33:1106-1111. [PMID: 29142547 PMCID: PMC5673716 DOI: 10.12669/pjms.335.13210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: The tendency to autoimmune diseases has been reported to be increased in beta thalassemia minor (BTM). The aim of this study was to evaluate whether thyroid autoimmunity is higher in BTM. Methods: Patients with BTM (n=86) and a healthy control group (n=93) were included in this cross-sectional case-control study. The two groups were compared in terms of anti-thyroglobulin (anti-TG) and anti-thyroid peroxidase (anti-TPO) and thyroid hormones. Results: In the BTM group, thyroid hormones and serum anti-TG and anti-TPO antibody levels were not statistically different from those of the control group. The BTM and control groups were similar in terms of anti-thyroid antibody (ATA) positivity prevalence. In the BTM group, anti-TG was 11.6% and anti-TPO was 14% positive, while these values were 14% and 12.9% positive, respectively in the control group (p=0.806 and p=0.989, respectively). The proportion of anti-TG and/or anti-TPO antibody positive subjects was found to be 20.9% in the BTM group, and 20.4% in the control group (p=0.919). The ratios of subjects with euthyroidism, hyperthyroidism and hypothyroidism were similar in both groups. Conclusions: As the thyroid autoimmunity prevalence in the BTM group was not increased compared to the control group, it can be considered that there is no necessity for routine ATA and thyroid hormone testing in subjects with BTM.
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Affiliation(s)
- Ali Ramazan Benli
- Ali Ramazan Benli, Department of Family Medicine, Faculty of Medicine, Karabuk University, 78200, Karabuk, Turkey
| | - Sati Sena Yildiz
- Sati Sena Yildiz, Department of Internal Medicine, Faculty of Medicine, Bezmialem Vakif University, 34093, Istanbul, Turkey
| | - Mehmet Ali Cikrikcioglu
- Mehmet Ali Cikrikcioglu, Department of Internal Medicine, Faculty of Medicine, Bezmialem Vakif University, 34093, Istanbul, Turkey
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Hui SYA, Sahota DS, Lao TT. Impact of the two-dose rubella vaccination regimen on incidence of rubella seronegativity in gravidae aged 25 years and younger. PLoS One 2017; 12:e0183630. [PMID: 28854204 PMCID: PMC5576672 DOI: 10.1371/journal.pone.0183630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/08/2017] [Indexed: 11/19/2022] Open
Abstract
Objective This study compared the incidence of rubella seronegativity among gravidae of 25 year-old and younger, between those born in Hong Kong after 1983 when the two-dose rubella vaccination was implemented, versus gravidae born before, to examine the impact of the two-dose regimen. Methods In this retrospective cohort study, the incidence of antenatal rubella seronegativity in our parturients managed in1997-2015 was analysed by their age from ≤16 to 25 years, and the effect of year of birth was determined adjusting for confounding factors including teenage status, obstetric history, anthropometric factors, and health parameters including anaemia, thalassaemia trait and hepatitis B carrier status. Results Among the 12743 gravidae, the 6103 gravidae born after 1983 had overall higher rubella seronegativity (9.1% versus 4.4%, OR 2.061, 95% CI 1.797–2.364), with significant difference (p = 0.006) and inverse correlation (p<0.001) with age, in contrast to the 6640 gravidae born in/before 1983 whom there was significant difference (p = 0.027) but a positive correlation (p = 0.008) with age. For each year of age, the former had significantly higher incidence of rubella seronegativity except for those of ≤16 years. Regression analysis confirmed that birth after 1983 was independently associated with rubella seronegativity (aOR 2.207, 95% CI 1.902–2.562). Conclusion There was a significant trend between rubella seronegativity with age in young gravidae, but the pattern was opposite between gravidae born after versus in/before 1983, with the former having a higher incidence of seronegativity at all ages. Young women covered by the two-dose rubella immunisation programme have a paradoxically higher incidence of rubella seronegativity.
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Affiliation(s)
- Shuk Yi Annie Hui
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Daljit S Sahota
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Terence T Lao
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
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23
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Traisrisilp K, Jatavan P, Tongsong T. A retrospective comparison of pregnancy outcomes between women with alpha-thalassaemia 1 trait and normal controls. J OBSTET GYNAECOL 2017; 37:1000-1003. [PMID: 28599577 DOI: 10.1080/01443615.2017.1313822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The objective of this retrospective cohort study was to compare pregnancy outcomes between low-risk pregnant women with alpha-thalassaemia-1 trait and normal controls. The database of the Maternal-Foetal Medicine unit was used to identify low-risk singleton pregnant women complicated by alpha-thalassaemia-1 trait who gave birth between January 2002 and October 2014. The low-risk pregnancies with non-carrier status for thalassaemia were assigned into the control group, with a control-to-case ratio of 10:1. During the study period, 595 women with alpha-thalassaemia-1 trait and 5950 normal controls were identified. There was no significant difference in the incidence of preterm birth and most obstetric outcomes between the two groups. However, a statistically significant difference was detected between them in terms of gestational age at delivery, 37.76 ± 2.81 vs. 38.11 ± 2.50 weeks (p = .001), birth weight, 2876 ± 581 vs. 2948 ± 527 g (p = .002) as well as the rate of low-birth weight, 17.1 vs. 12.8% (p = .002). In conclusion, this study provides new insights that alpha-thalassaemia-1 trait has minimal effect on gestational age at delivery and low-birth weight whereas other common adverse pregnancy outcomes are not increased. Impact statement What is already known on this subject: Thalassaemia trait is associated with some degree of anaemia. What the results of this study add: The prevalence of common adverse outcomes such as preterm birth, stillbirth, low Apgar scores and pregnancy-induced hypertension were not significantly different between both the groups, possibly caused by too small sample size to gain enough power. However, the rate of low-birth weight was significantly increased among pregnancy with alpha-thalassaemia-1 trait. What the implications are of these findings for clinical practice and/or further research: The information may be provided for alpha thalassaemia-1 trait mothers and their families. Physicians should guard against the occurrence of adverse pregnancy in these mothers. Prospective control study should be conducted to overcome the limitation of retrospective nature.
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Affiliation(s)
- Kuntharee Traisrisilp
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Phudit Jatavan
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Theera Tongsong
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
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Petrakos G, Andriopoulos P, Tsironi M. Pregnancy in women with thalassemia: challenges and solutions. Int J Womens Health 2016; 8:441-51. [PMID: 27660493 PMCID: PMC5019437 DOI: 10.2147/ijwh.s89308] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Advances in treatment of thalassemia have led to the aging of thalassemic patients, and consequently concern about successful reproductive outcome is augmented. Although women with thalassemia intermedia only were considered competent of achieving pregnancy, case series reveal the willingness of both thalassemia major and thalassemia intermedia women to have a family. Pregnancy in general is characterized by dynamic multiple-system changes and increased susceptibility to oxidative stress, while homozygous, transfusion-dependent, β-thalassemia patients manifest cardiac, hepatic, endocrine, and metabolic disorders attributable to chronic anoxia and iron overload and thalassemia intermedia, usually nontransfused, is associated with augmented risk of thromboembolic events. Pregnancy in thalassemia should be considered a high risk for both mother and fetus, and favorable outcomes are the result of continuous preconception, antenatal, and postpartum assessment and management by a team of thalassemia experts.
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Affiliation(s)
- George Petrakos
- Department of Nursing, University of Peloponnese, Sparta, Greece
| | | | - Maria Tsironi
- Department of Nursing, University of Peloponnese, Sparta, Greece
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Roth CK, Puttbrese A, Ottley C. Thalassemia Syndromes in Pregnancy. Nurs Womens Health 2016; 20:415-20. [PMID: 27520605 DOI: 10.1016/j.nwh.2016.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Thalassemia syndromes are becoming more common in the United States as the population becomes more diverse. To provide appropriate care to this patient population, nurses must know that thalassemia syndromes are classified into two main types, α-thalassemia and β-thalassemia. α-Thalassemia is further delineated into four clinical patterns: silent carrier state, mild α-thalassemia, hemoglobin H disease, and hydrops fetalis. Understanding each of these complex anemias and their potential effects on a pregnant woman and her fetus will enable nurses to interpret these women's unique laboratory test results. Intervention when necessary with appropriate treatment may lead to optimal outcomes for women and newborns.
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Therapeutic effect of Colla corii asini on improving anemia and hemoglobin compositions in pregnant women with thalassemia. Int J Hematol 2016; 104:559-565. [DOI: 10.1007/s12185-016-2069-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/14/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
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Abstract
Beta-thalassemia (BTM) major is the most common haemoglobin disorder in the world, with high prevalence in people of Mediterranean, Arab or Asian origin. It has been estimated that about 1.5% of the global population (80-90 million people) are carriers of BTM. In patients with BTM, long-term transfusion therapy for the correction of anaemia leads to toxic iron overload, resulting in significant morbidity including liver damage, cardiac complications and endocrine dysfunction. The commonest abnormality is hypogonadotropic hypogonadism, which presents with primary amenorrhoea, delayed puberty or secondary amenorrhoea with consequent infertility. Nevertheless, current improvements in the management of thalassemia disorders offer patients the possibility of having a regularly functioning reproductive system and increased chances of achieving a pregnancy. The aim of the present review is to analyse all aspects of fertility management in BTM women, by examining the main causes of infertility, in order to give practical tools to ensure a complete diagnostic work-up and discuss intervention options to guarantee maximum reproductive health.
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Affiliation(s)
- Maria Antonietta Castaldi
- a Department of the Woman, the Child, and General and Specialized Surgery , Second University of Naples , Naples , Italy
| | - Luigi Cobellis
- a Department of the Woman, the Child, and General and Specialized Surgery , Second University of Naples , Naples , Italy
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Abstract
Anemia is a common problem in primary care. Classification based on mean cell volume narrows the differential diagnosis and directs testing. A marked macrocytosis is characteristic of vitamin B12 and folate deficiencies, certain medications, and primary bone marrow disorders. The three most common causes of microcytic anemia are iron deficiency, thalassemia trait, and anemia of inflammation. Additional laboratory testing is required for diagnosis. Determination of the rate of development of anemia and examination of a blood smear may provide diagnostic clues to guide more specialized testing. Diagnosis of iron, vitamin B12, or folate deficiency mandates determination of the underlying cause.
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Affiliation(s)
- Jody L Kujovich
- Department of Pediatric Hematology/Oncology, The Hemophilia Center, Oregon Health & Science University, 707 Southwest Gaines Street, Portland, OR 97239, USA.
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Ambroggio S, Peris C, Picardo E, Mitidieri M, Minniti E, Benedetto C, Gregori G, Baù MG. β-thalassemia patients and gynecological approach: review and clinical experience. Gynecol Endocrinol 2016; 32:171-6. [PMID: 26492849 DOI: 10.3109/09513590.2015.1109617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Significant improvements in therapy and life expectancy of β-thalassemia patients in last decades result in the need of commitment for gynecologists and obstetricians as the complexity of organ impairment needs a specific multidisciplinary approach. After a review of clinical manifestations of β-thalassemia from a gynecologic point of view, we present the experience of a gynecologic center in treating β-thalassemia patients from more than 20 years.
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Affiliation(s)
- Simona Ambroggio
- a CIDIMU, Centro Italiano di Diagnostica Medica Ultrasonica , Torino , Italia
| | - Clementina Peris
- b Gin&Co, Ginecologia Mini Invasiva e Senologia , Torino , Italia
| | | | | | | | | | - Gianluca Gregori
- e Ginecologia e Ostetricia 3, A.O.U. Città della Salute e della Scienza di Torino, Sant'Anna Hospital , Torino , Italy
| | - Maria G Baù
- e Ginecologia e Ostetricia 3, A.O.U. Città della Salute e della Scienza di Torino, Sant'Anna Hospital , Torino , Italy
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Piccoli GB, Postorino V, Cabiddu G, Ghiotto S, Guzzo G, Roggero S, Manca E, Puddu R, Meloni F, Attini R, Moi P, Guida B, Maxia S, Piga A, Mazzone L, Pani A, Postorino M. Children of a lesser god or miracles? An emotional and behavioural profile of children born to mothers on dialysis in Italy: a multicentre nationwide study 2000–12. Nephrol Dial Transplant 2015; 30:1193-1202. [DOI: 10.1093/ndt/gfv127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Al-Riyami N, Al-Khaduri M, Daar S. Pregnancy Outcomes in Women with Homozygous Beta Thalassaemia: A single-centre experience from Oman. Sultan Qaboos Univ Med J 2014; 14:e337-e341. [PMID: 25097768 PMCID: PMC4117658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/22/2014] [Accepted: 03/04/2014] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES Pregnancy in women with homozygous beta thalassaemia (HBT) carries a high risk to both the mother and fetus. The aim of this study was to investigate pregnancy outcomes among this group at a single tertiary centre. METHODS This retrospective descriptive study was conducted between January 2006 and December 2012 on all women with HBT who received prenatal care and subsequently delivered at Sultan Qaboos University Hospital, Muscat, Oman. Women who delivered elsewhere and women with the beta thalassaemia trait were excluded. RESULTS Ten women with HBT were studied with a total of 15 pregnancies and 14 live births. The mean maternal age ± standard deviation (SD) was 27.9 ± 3.7 years, with a range of 24-35 years. There were 14 spontaneous pregnancies and one pregnancy following hormone treatment. Eight women had been on chelation therapy before pregnancy, one of whom needed chelation during late pregnancy. Of the pregnancies, 93% had a successful outcome with a mean ± SD gestational age at delivery of 38.6 ± 0.9 weeks, with a range of 37-40 weeks. Eight babies (57%) were delivered by Caesarean section. The mean ± SD birth weight was 2.6 ± 0.2 kg, with a range of 1.9-3.0 kg. Three babies (21%) were born with low birth weights. CONCLUSION Pregnancy is safe and usually has a favourable outcome in patients with HBT, provided that a multidisciplinary team is available. This is the first study of Omani patients with HBT whose pregnancies have resulted in a successful outcome.
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Affiliation(s)
- Nihal Al-Riyami
- Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital
| | - Maha Al-Khaduri
- Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital
| | - Shahina Daar
- Department of Haematology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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Voskaridou E, Balassopoulou A, Boutou E, Komninaka V, Christoulas D, Dimopoulou M, Delaki EE, Loukopoulos D, Terpos E. Pregnancy in beta-thalassemia intermedia: 20-year experience of a Greek thalassemia center. Eur J Haematol 2014; 93:492-9. [DOI: 10.1111/ejh.12387] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 12/30/2022]
Affiliation(s)
- Ersi Voskaridou
- Thalassemia Centre; ‘Laiko’ University General Hospital of Athens; Athens Greece
| | | | - Effrossyni Boutou
- Thalassemia Centre; ‘Laiko’ University General Hospital of Athens; Athens Greece
| | - Veroniki Komninaka
- Thalassemia Centre; ‘Laiko’ University General Hospital of Athens; Athens Greece
| | | | - Maria Dimopoulou
- Thalassemia Centre; ‘Laiko’ University General Hospital of Athens; Athens Greece
| | | | - Dimitris Loukopoulos
- Hematology Research Laboratory; Biomedical Research Foundation; Academy of Athens; Athens Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics; School of Medicine; National and Kapodistrian University of Athens; Athens Greece
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Berry SM, Stone J, Norton ME, Johnson D, Berghella V. Fetal blood sampling. Am J Obstet Gynecol 2013; 209:170-80. [PMID: 23978246 DOI: 10.1016/j.ajog.2013.07.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We sought to review indications, technical aspects, risks, and recommendations for fetal blood sampling (FBS). METHODS A systematic review was performed using MEDLINE, PubMed, EMBASE, and Cochrane Library using the terms "fetal blood sampling," "percutaneous umbilical blood sampling," and "cordocentesis." The search was restricted to English-language articles published from 1966 through July 2012. Priority was given to articles reporting original research, in particular randomized controlled trials, although review articles and commentaries also were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion in this document. Evidence reports and guidelines published by organizations or institutions such as the National Institutes of Health, Agency for Health Research and Quality, American Congress of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine were also reviewed, and additional studies were located by reviewing bibliographies of identified articles. Grade (Grading of Recommendations Assessment, Development, and Evaluation) methodology was employed for defining strength of recommendations and rating quality of evidence. Consistent with US Preventive Task Force guidelines, references were evaluated for quality based on the highest level of evidence. RESULTS AND RECOMMENDATIONS Ultrasound-guided FBS is the only procedure that provides direct access to the fetal circulation. When invasive testing is planned for suspected severe fetal anemia or thrombocytopenia, we recommend FBS as the procedure of choice, with availability of immediate transfusion if confirmed. We recommend against the use of FBS for indications in which other less invasive, and therefore lower risk, alternatives are available. The overall success rate of FBS is high, and blood samples can be obtained in >98% of patients. We suggest that counseling for FBS include discussion about the potential risk of FBS that may include, but may not be limited to: bleeding from puncture site (20-30%); fetal bradycardia (5-10%); pregnancy loss (≥1.3%, depending on indication, gestational age, and placental penetration); and vertical transmission of hepatitis or human immunodeficiency virus. We recommend that FBS be performed by experienced operators at centers with expertise in invasive fetal procedures when feasible.
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Impact of sickle cell disease and thalassemias in infants on birth outcomes. Eur J Obstet Gynecol Reprod Biol 2013; 170:324-8. [PMID: 23859868 DOI: 10.1016/j.ejogrb.2013.06.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 05/21/2013] [Accepted: 06/18/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The contribution of sickle cell disease (SCD) and other common thalassemias in infants to adverse birth outcomes is under-studied. We therefore sought to compare adverse birth outcomes in infants with and without hemoglobinopathy. STUDY DESIGN Retrospective cohort study utilizing a population-based dataset from Florida (1998-2007, n=1,564,038). The primary outcomes were low birthweight (LBW), very low birthweight (VLBW), preterm birth (PTB), very preterm birth (VPTB) and small for gestational age (SGA). We used propensity scores to match infants with hemoglobinopathy to those without hemoglobinopathy on selected variables. To approximate relative risks, we generated adjusted odds ratios (AOR) and 95% confidence intervals (CI) from logistic regression models and accounted for the matched design using generalized estimating equations framework. RESULTS Infants with SCD or thalassemia had a heightened risk for LBW (AOR=1.58, 95% CI: 1.29-1.93), VLBW (AOR=3.01, 95% CI: 2.12-4.25), PTB (AOR=1.36, 95% CI: 1.12-1.65), VPTB (AOR=2.70, 95% CI: 1.93-3.78), and neurological conditions (AOR=2.04, 95% CI: 1.48-2.81) compared to infants without hemoglobinopathy. CONCLUSION Infants with SCD or thalassemia experience considerably higher risks for multiple infant morbidities. Our findings are potentially important in prenatal counseling, as well as for targeted care of affected pregnancies in the prenatal period.
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Pennell DJ, Udelson JE, Arai AE, Bozkurt B, Cohen AR, Galanello R, Hoffman TM, Kiernan MS, Lerakis S, Piga A, Porter JB, Walker JM, Wood J. Cardiovascular function and treatment in β-thalassemia major: a consensus statement from the American Heart Association. Circulation 2013; 128:281-308. [PMID: 23775258 DOI: 10.1161/cir.0b013e31829b2be6] [Citation(s) in RCA: 261] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This aim of this statement is to report an expert consensus on the diagnosis and treatment of cardiac dysfunction in β-thalassemia major (TM). This consensus statement does not cover other hemoglobinopathies, including thalassemia intermedia and sickle cell anemia, in which a different spectrum of cardiovascular complications is typical. There are considerable uncertainties in this field, with a few randomized controlled trials relating to treatment of chronic myocardial siderosis but none relating to treatment of acute heart failure. The principles of diagnosis and treatment of cardiac iron loading in TM are directly relevant to other iron-overload conditions, including in particular Diamond-Blackfan anemia, sideroblastic anemia, and hereditary hemochromatosis. Heart failure is the most common cause of death in TM and primarily results from cardiac iron accumulation. The diagnosis of ventricular dysfunction in TM patients differs from that in nonanemic patients because of the cardiovascular adaptation to chronic anemia in non-cardiac-loaded TM patients, which includes resting tachycardia, low blood pressure, enlarged end-diastolic volume, high ejection fraction, and high cardiac output. Chronic anemia also leads to background symptomatology such as dyspnea, which can mask the clinical diagnosis of cardiac dysfunction. Central to early identification of cardiac iron overload in TM is the estimation of cardiac iron by cardiac T2* magnetic resonance. Cardiac T2* <10 ms is the most important predictor of development of heart failure. Serum ferritin and liver iron concentration are not adequate surrogates for cardiac iron measurement. Assessment of cardiac function by noninvasive techniques can also be valuable clinically, but serial measurements to establish trends are usually required because interpretation of single absolute values is complicated by the abnormal cardiovascular hemodynamics in TM and measurement imprecision. Acute decompensated heart failure is a medical emergency and requires urgent consultation with a center with expertise in its management. The first principle of management of acute heart failure is control of cardiac toxicity related to free iron by urgent commencement of a continuous, uninterrupted infusion of high-dose intravenous deferoxamine, augmented by oral deferiprone. Considerable care is required to not exacerbate cardiovascular problems from overuse of diuretics or inotropes because of the unusual loading conditions in TM. The current knowledge on the efficacy of removal of cardiac iron by the 3 commercially available iron chelators is summarized for cardiac iron overload without overt cardiac dysfunction. Evidence from well-conducted randomized controlled trials shows superior efficacy of deferiprone versus deferoxamine, the superiority of combined deferiprone with deferoxamine versus deferoxamine alone, and the equivalence of deferasirox versus deferoxamine.
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Hanprasertpong T, Kor-anantakul O, Leetanaporn R, Suntharasaj T, Suwanrath C, Pruksanusak N, Pranpanus S. Pregnancy outcomes amongst thalassemia traits. Arch Gynecol Obstet 2013; 288:1051-4. [PMID: 23681496 PMCID: PMC3824192 DOI: 10.1007/s00404-013-2886-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 05/06/2013] [Indexed: 11/30/2022]
Abstract
Objective To compare the pregnancy outcome between pregnancies affected and not affected by thalassemia trait. Methods A retrospective case–control cohort study was conducted on singleton pregnant women who attended antenatal care and delivered at Songklanagarind Hospital. All of the participating thalassemia trait pregnant women were diagnosed based on hemoglobin typing and/or DNA analysis. A ratio of around 1–1 was used to compare their pregnancy outcomes with normal pregnant women. Results Seven hundred thirty-nine thalassemia trait and 799 normal pregnant women were included in the study. All of the women were Thai nationals living in the Southern Region of Thailand and nearly all of them had spontaneously conceived. Maternal complication rates of gestational diabetes, preterm birth, antepartum bleeding, postpartum bleeding, shoulder dystocia and puerperal morbidity, and the rates of neonatal complications: macrosomia, fetal weight <2,000 g, intrauterine growth restriction (IUGR), stillbirth, low Apgar score (<7) at 1 and 5 min and NICU admission, were not significantly different between the two groups. The rate of pre-eclampsia, however, was significantly different, with RRs of 1.73 (CI 1.01–3.00). Conclusion The thalassemia trait condition did not affect the risk of gestational diabetes, postpartum hemorrhage, stillbirth, preterm birth and puerperal morbidity. However, pre-eclampsia should be warranted especially among nulliparous and high-BMI pregnant women.
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Affiliation(s)
- Tharangrut Hanprasertpong
- Department of Obstetrics and Gynecology, Faculty of Medicine Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand,
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Kim D, Mendez-Figueroa H, Anderson BL. Pregnancy with a severe hemoglobinopathy: unintended consequences of transfusions. Case Rep Obstet Gynecol 2013; 2013:413502. [PMID: 23424691 PMCID: PMC3568875 DOI: 10.1155/2013/413502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 01/10/2013] [Indexed: 11/30/2022] Open
Abstract
We report a case of a pregnant woman with a complex hemoglobinopathy who developed a symptomatic anemia at 28 weeks of gestation and was treated with multiple transfusions of type-specific packed red blood cells. Shortly thereafter, she developed a fever and joint pains, along with laboratory values consistent with hemolysis. Timing suggested a delayed transfusion reaction. An extensive evaluation including red blood cell antigen identification and cross-reaction failed to reveal the cause for her hemolysis. Despite her critically low hemoglobin levels, her transfusions were withheld in an attempt to allow the patient to recover conservatively. With this strategy, her hemoglobin remained below her baseline, but her symptoms began to improve. Her laboratory values normalized, and hemolysis was no longer evident. Three weeks later, her hemoglobin levels returned back to her baseline without additional intervention. She went on to deliver a full-term male infant.
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Affiliation(s)
- David Kim
- Department of Obstetrics and Gynecology, Women & Infants Hospital, The Warren Alpert Medical School of Brown University, Providence, RI 02905, USA
| | - Hector Mendez-Figueroa
- Maternal-Fetal Medicine Clinic, Department of Obstetrics and Gynecology, Women & Infants Hospital, The Warren Alpert Medical School of Brown University, 101 Dudley Street, 3rd Floor, Providence, RI 02905-2401, USA
| | - Brenna L. Anderson
- Maternal-Fetal Medicine Clinic, Department of Obstetrics and Gynecology, Women & Infants Hospital, The Warren Alpert Medical School of Brown University, 101 Dudley Street, 3rd Floor, Providence, RI 02905-2401, USA
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