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Tuo Y, Li Y, Li Y, Ma J, Yang X, Wu S, Jin J, He Z. Global, regional, and national burden of thalassemia, 1990-2021: a systematic analysis for the global burden of disease study 2021. EClinicalMedicine 2024; 72:102619. [PMID: 38745964 PMCID: PMC11090906 DOI: 10.1016/j.eclinm.2024.102619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/06/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
Background Anemia is a significant contributor to the global disease burden, of which thalassemia is the most common hereditary anaemic disease. Previous estimates were based on data that were geographically limited and lacked comprehensive global analysis. This study provides the prevalence, incidence, mortality and disability-adjusted life years (DALYs) of thalassemia in 204 countries and regions of thalassemia between 1990 and 2021, focusing on the age structure and time trends of the disease burden. To provide effective information for health policy, allocation of medical resources and optimization of patient management programs. Methods Using the standardised Global Burden of Disease (GBD) methodologies, we aimed to derive a more precise representation of the health burden posed by thalassemia by considering four distinct types of epidemiological data, namely the incidence at birth, prevalence, mortality and DALYs. The presented data were meticulously estimated and displayed both as numerical counts and as age-standardised rates per 100,000 persons of the population, accompanied by uncertainty interval (UI) to highlight potential statistical variability. The temporal trends spanning the years 1990-2021 were subjected to a rigorous examination utilizing Joinpoint regression analysis. This methodological approach facilitated the computation of the annual percentage change (APC) and the average annual percentage change (AAPC), along with their corresponding 95% confidence intervals (CIs). Findings Globally, the age-standardized prevalence rates (ASPR), age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and age-standardized DALYs rates for thalassemia in 2021 were 18.28 per 100,000 persons (95% UI 15.29-22.02), 1.93 per 100,000 persons (95% UI 1.51-2.49), 0.15 per 100,000 persons(95% UI 0.11-0.20), and 11.65 per 100,000 persons (95% UI 8.24-14.94), respectively. Compared to 1990, these rates have decreased by 0.18 (95% UI -0.22 to -0.14), 0.25 (95% UI -0.30 to -0.19), 0.48 (95% UI -0.60 to -0.28), and 0.49 (95% UI -0.62 to -0.29) respectively. In 2021, the ASIR of thalassemia was highest in East Asia at 7.35 per 100,000 persons (95% UI 5.37-10.04), and ASMR was highest in Southeast Asia at 0.37 per 100,000 persons (95% UI 0.29-0.45).Gender comparisons showed negligible differences in disease burden, with the highest prevalence noted in children under five, decreasing with age. The global ASPR and ASMR declined from 1990 to 2021 overall, though an increasing trend in prevalence was found among the elderly. Joinpoint analysis revealed that the global ASPR increased between 2018 and 2021 (APC = 9.2%, 95% CI: 4.8%-13.8%, P < 0.001), ASIR decreased (APC = -7.68%, 95% CI: -10.88% to -4.36%, P < 0.001), and there was a significant rise in ASMR from 2019 to 2021 (APC = 4.8%, 95% CI: 0.1%-9.6%, P < 0.05). Trends in ASPR and ASMR varied across regions, with notable changes in South Asia. Interpretation The global burden of thalassemia, reflected in its prevalence, incidence, mortality, and DALYs, exhibits significant disparities. Geographic and demographic shifts in disease distribution have been observed from 1990 to 2021, with an overall decrease in burden, yet an increase in cases among the elderly population. Analysis of epidemiological trends over time highlights the influence of health policies and significant public health interventions on thalassemia outcomes. There data are crucial for healthcare professionals, policymakers, and researchers to refine and enhance management strategies, aiming to further mitigate thalassemia's global impact. Funding National Natural Science Foundation of China; Guizhou Province Science and Technology Project; Guizhou Province Science and Technology Foundation of Health Commission.
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Affiliation(s)
- Yuanyuan Tuo
- Department of Pediatric Hematology, The Affiliated Hospital of Guizhou Medical University, Department of Pediatrics, School of Clinical Medicine, Guizhou Medical University, Guiyang, 550004, China
| | - Yang Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, 300020, China
| | - Yan Li
- Department of Pediatric Hematology, The Affiliated Hospital of Guizhou Medical University, Department of Pediatrics, School of Clinical Medicine, Guizhou Medical University, Guiyang, 550004, China
| | - Jianjuan Ma
- Department of Pediatric Hematology, The Affiliated Hospital of Guizhou Medical University, Department of Pediatrics, School of Clinical Medicine, Guizhou Medical University, Guiyang, 550004, China
| | - Xiaoyan Yang
- Department of Pediatric Hematology, The Affiliated Hospital of Guizhou Medical University, Department of Pediatrics, School of Clinical Medicine, Guizhou Medical University, Guiyang, 550004, China
| | - Shasha Wu
- Department of Pediatric Hematology, The Affiliated Hospital of Guizhou Medical University, Department of Pediatrics, School of Clinical Medicine, Guizhou Medical University, Guiyang, 550004, China
| | - Jiao Jin
- Department of Pediatric Hematology, The Affiliated Hospital of Guizhou Medical University, Department of Pediatrics, School of Clinical Medicine, Guizhou Medical University, Guiyang, 550004, China
| | - Zhixu He
- Department of Pediatric Hematology, The Affiliated Hospital of Guizhou Medical University, Department of Pediatrics, School of Clinical Medicine, Guizhou Medical University, Guiyang, 550004, China
- Collaborative Innovation Center for Tissue Injury Repair and Regenerative Medicine, Zunyi Medical University, Zuiyi, 563000, China
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Chinnaiyan S, Sylvia J, Kothandaraman S, Palanisamy B. Quality of life and thalassemia in India: A scoping review. J Family Med Prim Care 2024; 13:1183-1190. [PMID: 38827716 PMCID: PMC11141992 DOI: 10.4103/jfmpc.jfmpc_1787_23] [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] [Received: 11/07/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 06/04/2024] Open
Abstract
In recent years, a multitude of studies have been conducted to investigate the assessment of quality of life (QoL) among individuals affected by thalassemia. This scoping review aimed to examine the existing knowledge regarding the QoL and its associated factors among individuals with thalassemia in India. Databases, such as PubMed, SCOPUS, Web of Science, and the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines, were searched. A total of nine articles were included in the review. The included studies mainly investigated children. The Pediatric Quality of Life Inventory (PedsQL) is the most common instrument used most often. Overall, the research findings indicate that individuals who underwent blood transfusion exhibited a lower QoL than those who did not receive blood transfusion. Additionally, it was observed that children diagnosed with thalassemia reported a lower QoL than adults. Nevertheless, the studies exhibited notable methodological deficiencies that constrained the validity and generalizability of the results. Hence, it is imperative to undertake comprehensive QoL research encompassing all regions of India and various thalassemia populations within the country to bridge this evidentiary void.
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Affiliation(s)
- Saravanan Chinnaiyan
- SRM School of Public Health, SRM Institute of Science and Technology, Chengalpattu Dist., Tamil Nadu, India
| | - Jenifer Sylvia
- SRM School of Public Health, SRM Institute of Science and Technology, Chengalpattu Dist., Tamil Nadu, India
| | - Sowmiya Kothandaraman
- SRM School of Public Health, SRM Institute of Science and Technology, Chengalpattu Dist., Tamil Nadu, India
| | - Bharathi Palanisamy
- SRM School of Public Health, SRM Institute of Science and Technology, Chengalpattu Dist., Tamil Nadu, India
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Sumedha D, Anita K. Prevalence of beta thalassemia carriers in India: a systematic review and meta-analysis. J Community Genet 2023; 14:527-541. [PMID: 37861936 PMCID: PMC10725409 DOI: 10.1007/s12687-023-00683-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
A large number of studies have reported that the prevalence of beta thalassemia carriers in India varies by ethnic groups. The objective of this study was to conduct a systematic review of the published studies and conduct a meta-analysis to determine the prevalence of beta thalassaemia carriers in India. A PubMed database search using keywords "beta thalassaemia AND India" identified 1088 articles of which 69 articles were included in the review. Studies using diagnostic tests and methods recommended by the International Council for Standardization in Haematology were used for calculation of pooled prevalence. Pooled prevalence was calculated using a random effects model using Review Manager version 5.3. Studies had screened five categories of populations, that is, the general population; tribal groups, communities not belonging to tribal groups, persons with anemia, and persons referred with a suspicion of hemoglobinopathy. This heterogeneity contributed to a high pooled prevalence of beta thalassemia carriers of 8.23% (95% CI 7.36-9.10). Sub-group analysis however yielded 3.74% (95% CI 2.52-4.97) pooled prevalence of beta thalassemia carriers in the general population. It was 4.6% (95% CI 3.2-6.2) among tribal groups. Quality of prevalence studies was limited by methodological issues including non-random sampling methods, heterogeneity of population types screened, and lack of use of recommended diagnostic cut-offs. Prevalence of beta thalassemia carriers was similar in tribal populations and the general population, indicating the need to further investigate the prevalence of beta thalassemia carriers in tribal groups.
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Affiliation(s)
- Dharmarajan Sumedha
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University (University of Pune), Pune, 411007, India
| | - Kar Anita
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University (University of Pune), Pune, 411007, India.
- Birth Defects Research Foundation, Pune, 411020, India.
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Vachhani NA, Vekariya DJ, Colah RB, Kashiyani HN, Nandani SL. Spectrum of β-Thalassemia and Other Hemoglobinopathies in the Saurashtra Region of Gujarat, India: Analysis of a Large Population Screening Program. Hemoglobin 2022; 46:285-289. [PMID: 36367309 DOI: 10.1080/03630269.2022.2142608] [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: 11/13/2022]
Abstract
Hemoglobinopathies are common genetic disorders of the hemoglobin (Hb) molecule. Globally, 7.0% of the population are carriers of thalassemia with 300,000-400,000 affected births each year. There are >40 million carriers of β-thalassemia (β-thal) in India with 10,000-12,000 affected births every year. This makes control programs crucial in this vast and diverse country. The present study was undertaken to find out the burden of hemoglobinopathies, and in particular, the prevalence of β-thal carriers in the population of Saurashtra region of Gujarat in Western India. A total of 16,780 individuals, including school and college students, were screened. Complete blood counts (CBCs) and high performance liquid chromatography (HPLC) analysis were performed. We detected 1891 (11.26%) individuals with different hemoglobinopathies, of whom 758 (4.52%) were diagnosed to carry β-thal trait, 104 (0.62%) carried Hb D-Punjab (HBB: c.364G>C) trait, 61 (0.36%) carried sickle cell trait, 32 (0.19%) carried δβ-thal trait/HPFH (hereditary persistence of fetal Hb) trait, and other hemoglobinopathies were identified in smaller numbers (0.15%). We encountered 27 individuals with mean corpuscular Hb (MCH) <27.0 pg and mean corpuscular volume (MCV) <80.0 fL levels, who had borderline Hb A2 levels (3.2-3.5%). Twenty castes showed the presence of β-thal or other hemoglobinopathies. A high prevalence of β-thal was found in the Sindhis (11.67%), Lohanas (9.71%), Brahmins (6.31%), Bharvads (6.94%), Harijans (7.57%) and Vankars (7.77%). All the heterozygotes were given appropriate counseling. A multi pronged approach, including screening of high school and college students, needs to be considered for this vast and ethnically diverse country to reduce the burden of hemoglobinopathies.
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Affiliation(s)
- Nishith A Vachhani
- Life Blood Centre, Indian Medical Scientific Research Foundation, Rajkot, India
| | - Daya J Vekariya
- Life Blood Centre, Indian Medical Scientific Research Foundation, Rajkot, India
| | - Roshan B Colah
- Department of Haematogenetics, National Institute of Immunohaematology, King Edward Hospital Campus, Parel, Mumbai, India
| | - Heena N Kashiyani
- Life Blood Centre, Indian Medical Scientific Research Foundation, Rajkot, India
| | - Sanjeev L Nandani
- Life Blood Centre, Indian Medical Scientific Research Foundation, Rajkot, India
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Abstract
India bears a huge burden of hemoglobinopathies, and the most prevalent is thalassemia. The different types of thalassemia include minor, major and intermedia, based on the α/β-globin chain inequality. This review aimed to understand the current prevalence of thalassemia in different regions of India and communities affected by it, along with the management of β-thalassemia major (β-TM) and β-thalassemia (β-thal) minor patients. A comprehensive electronic search for relevant articles was conducted using two databases, i.e. PubMed and Science Direct. Articles published in English from India between January 2009 and September 2021 were included. Studies from other countries, genetic and molecular characterization studies, and articles published in other languages were excluded. The prevalence of β-thal trait in Central India ranged between 1.4 and 3.4%, while 0.94% β-TM was reported among the patients with anemia. In South India, the prevalence of β-thal trait was between 8.50 and 37.90% and β-TM was reported to be between 2.30 and 7.47%. Northern and Western Indian states had a higher thalassemic burden. In Eastern India, tribal populations had a higher prevalence of β-thal trait (0.00-30.50%), β-TM (0.36-13.20%) and other hemoglobinopathies [Hb E (HBB: c.79G>A)/β-thal] (0.04-15.45%) than nontribal populations. Additionally, scheduled castes, scheduled tribes and other backward classes of low socioeconomic status and low literacy rates were affected by β-thal. Almost all Indian states reported β-thal; however, it is mostly concentrated in eastern and western parts of the country. Well-integrated strategies and effective implementation are needed at State and National levels to minimize the burden of β-thal.
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Affiliation(s)
- Surabhi S Yadav
- Nutrition and Dietetics Programme, Symbiosis Institute of Health Sciences (SIHS), Symbiosis International (Deemed University), Pune, India
| | - Pooja Panchal
- Nutrition and Dietetics Programme, Symbiosis Institute of Health Sciences (SIHS), Symbiosis International (Deemed University), Pune, India
| | - Kavitha C Menon
- Nutrition and Dietetics Programme, Symbiosis Institute of Health Sciences (SIHS), Symbiosis International (Deemed University), Pune, India
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Colah RB, Seth T. Thalassemia in India. Hemoglobin 2022; 46:20-26. [PMID: 35950587 DOI: 10.1080/03630269.2021.2008958] [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: 11/04/2022]
Abstract
Management and control of hemoglobinopathies are a challenge in India where 67.0% of people reside in rural regions. The GDP spent on health is one of the lowest (1.3%) resulting in high out-of-pocket expenses. The β-thalassemias are prevalent with an estimated 7500-12000 new births each year. Hb S (HBB: c.20A>T) and Hb E (HBB: c.79G>A) are also common regionally. Over 80 β-thalassemia (β-thal) mutations have been characterized in Indians. The δ gene mutations are increasingly being described and their coinheritance in β-thal carriers leads to a reduction in Hb A2 levels and a misdiagnosis of carriers. Around 15-20 centers offer prenatal diagnosis (PND) mainly in urban regions. The projected annual cost of care of β-thal patients over a decade (2016-2026) will increase from INR30,000 (US$448) million to INR55,000 (US$820) million if all patients are adequately treated. Cost comparisons are difficult to make with other international studies as the standard of care, cost of medicines and other services vary in different countries. Several centers provide hematopoietic stem cell transplants (HSCTs) for thalassemias, however, only around 250 HSCTs are done annually. Although the cost is high, financial assistance is available for a few patients. There are disparities in the quality of care and to address this a National Policy has been proposed for the management and prevention of hemoglobinopathies that will embark on a comprehensive program, providing adequate care and augmenting the existing public health care services. It will also include training, genetic counseling and easier access to preventive options and a National Registry.
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Affiliation(s)
- Roshan B Colah
- Department of Haematogenetics, Indian Council of Medical Research, National Institute of Immunohaematology, King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Tulika Seth
- Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
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Choubisa SL, Choubisa A. Status of erythrocyte genetic disorders in people of desert and humid environments in Rajasthan, India: focus on natural selection in tribals against malaria. PROCEEDINGS OF THE INDIAN NATIONAL SCIENCE ACADEMY 2021. [DOI: 10.1007/s43538-021-00045-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dharmarajan S, Pawar A, Bhide P, Kar A. Undiagnosed haemoglobinopathies among pregnant women attending antenatal care clinics in Pune, India. J Community Genet 2021; 12:337-344. [PMID: 33486692 PMCID: PMC8241948 DOI: 10.1007/s12687-021-00505-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022] Open
Abstract
Pregnant women with iron deficiency and those who are carriers of haemoglobinopathies present with anaemia of varying severity. There is no antenatal screening for haemoglobinopathies in India. The objective of this study was to determine the prevalence of undiagnosed haemoglobinopathy carriers in a random sample of pregnant women attending antenatal care clinics in Pune city, India. Biobanked DNA of 360 randomly selected pregnant women was genotyped for six common mutations and two common haemoglobin variants, HbS and HbE. Odds ratios (OR) with 95% confidence intervals were computed to determine association of carrier status with socio-demographic, haematological and clinical characteristics. The prevalence of undiagnosed haemoglobinopathy carriers was 6.3% (95% CI 4.2-9.4%) of which 3.3% (95% CI 1.9-5.7%) were beta thalassaemia carriers. There was an increased odds that beta thalassaemia carriers had moderate anaemia (OR 10.59, 95% CI 1.15-96.90). This study reveals the high prevalence of undiagnosed haemoglobinopathy carriers among pregnant women, indicating the need to immediately implement carrier screening and genetic counselling services across the country.
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Affiliation(s)
- Sumedha Dharmarajan
- School of Health Sciences, Savitribai Phule Pune University (University of Pune), Pune, 411007, India
| | - Ameya Pawar
- Department of Microbiology, Modern College of Arts, Science & Commerce, Pune, India
| | - Prajkta Bhide
- School of Health Sciences, Savitribai Phule Pune University (University of Pune), Pune, 411007, India
| | - Anita Kar
- School of Health Sciences, Savitribai Phule Pune University (University of Pune), Pune, 411007, India.
- Birth Defects and Childhood Disability Research Centre, Pune, 411020, India.
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Rao VR, Gupta G, Saroja K, Jain S. Identification and Development of a High-Risk District Model in the Prevention of β-Thalassemia in Telangana State, India. Hemoglobin 2020; 44:371-375. [PMID: 33003974 DOI: 10.1080/03630269.2020.1814805] [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: 10/23/2022]
Abstract
The burden of β-thalassemia (β-thal) is largely underestimated in India with a carrier frequency of 3.0-4.0% in general, whereas highly stratified frequencies of up to 17.0% are reported in local endogamous subpopulations. We have no idea whether β-thal carrier frequencies or β-thal major (β-TM) births are increasing or decreasing in the population. The cross-sectional nature of all carrier screening programs including large-scale task force and micro level, lack of registration of β-TM births and mechanism to modulate knowledge, awareness programs in a long-term perspective, all preempt impact assessment of preventive programs. During the implementation of a Telangana State Government-sponsored program on 'Micro profiling of β-thalassemia mutations in Telangana,' we documented extensive in-depth demographic information on each β-TM child of the study sample that included age-sex distributions, parental and grand-parental ethnic affiliations (local endogamous group level), birth places, marital migrations, endogamy and consanguinity to identify high-risk districts as ethno-geographic regions. In Telangana State, we found β-thal is widely prevalent in 31 districts and 48 local endogamous subpopulations. The present study provided a method of identification of four 'high-risk districts' and developed a district model for prevention on high priority in Telangana State. The model has the advantage of impact-assessment of all preventive programs in the district.
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Affiliation(s)
- Vadlamudi R Rao
- Thalassemia and Sickle Cell Society, Raghavendra Colony, Rajendra Nagar, Rangareddy District, Hyderabad, Telangana State, India.,Genome Foundation, Banjara Hills, Hyderabad, Telangana State, India
| | - Gaurav Gupta
- Genome Foundation, Banjara Hills, Hyderabad, Telangana State, India
| | - Kondaveeti Saroja
- Thalassemia and Sickle Cell Society, Raghavendra Colony, Rajendra Nagar, Rangareddy District, Hyderabad, Telangana State, India
| | - Suman Jain
- Thalassemia and Sickle Cell Society, Raghavendra Colony, Rajendra Nagar, Rangareddy District, Hyderabad, Telangana State, India
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Ghosh K, Patel P, Mishra K, Ghosh K. Inherited Thrombocytopenias: Combining High-Throughput Sequencing With Other Relevant Data. Clin Appl Thromb Hemost 2019; 25:1076029618820164. [PMID: 30808217 PMCID: PMC6714956 DOI: 10.1177/1076029618820164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kanjaksha Ghosh
- 1 Surat Raktadan Kendra & Research Centre, Surat, Gujarat, India
| | - Parizad Patel
- 1 Surat Raktadan Kendra & Research Centre, Surat, Gujarat, India
| | - Kanchan Mishra
- 1 Surat Raktadan Kendra & Research Centre, Surat, Gujarat, India
| | - Kinjalka Ghosh
- 2 Department of Clinical Biochemistry, Tata Cancer Hospital, Parel, Mumbai, India
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Gorakshakar AC, Breganza PV, Colaco SP, Shaikh RF, Bohra MY, Sawant PM, Nadkarni AH, Colah RB, Ghosh KK. Rare β- and δ-Globin Gene Mutations in the Pathare Prabhus: Original Inhabitants of Mumbai, India. Hemoglobin 2019; 42:297-301. [PMID: 30626279 DOI: 10.1080/03630269.2018.1544909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Genetic structure of the Indian population is influenced by waves of several immigrants from West Eurasia. Therefore, genetic information of various ethnic groups is valuable to understand their origins, the pattern of migration as well as the genetic relationship between them. No genetic data is available on Pathare Prabhu, which is a small indigenous Hindu community from Mumbai, Maharashtra State, India. The aim of this study was to screen the Pathare Prabhus for hemoglobinopathies, which is a major public health problem in India. Two hundred and fifty-seven unrelated Pathare Prabhus subjects were screened for various hemoglobinopathies. Complete blood counts (CBC) were done on an automated hematology counter. High performance liquid chromatography (HPLC) was used to identify β-thalassemia (β-thal) carriers. Molecular characterization of the β gene defects was done by reverse dot-blot hybridization, amplification refractory mutation system (ARMS) and DNA sequencing. Deletional α-thalassemia (α-thal) was detected by multiplex polymerase chain reaction (PCR). Hb A2-Saurashtra (HBD: c.301C>T) was identified by DNA sequencing; its modeling was also done. The prevalence of β-thal was 3.89%, while deletional α-thal was 5.4%. The initiation codon (ATG>ACG) (HBB: c.2T>C) was seen in eight individuals (80.0%), Hb D-Punjab (HBB: c.364G>C) and Hb A2-Saurashtra, was found in two and one individual, respectively. A community-specific β-thal mutation was found in Pathare Prabhus in significant proportions. This information is useful in developing an algorithm for a prenatal diagnosis (PND) program.
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Affiliation(s)
- Ajit C Gorakshakar
- a Department of Transfusion Medicine , National Institute of Immunohaematology, King Edward Memorial Hospital Campus , Parel , Mumbai , Maharashtra State , India
| | - Pearl V Breganza
- a Department of Transfusion Medicine , National Institute of Immunohaematology, King Edward Memorial Hospital Campus , Parel , Mumbai , Maharashtra State , India
| | - Stacy P Colaco
- a Department of Transfusion Medicine , National Institute of Immunohaematology, King Edward Memorial Hospital Campus , Parel , Mumbai , Maharashtra State , India
| | - Roshan F Shaikh
- a Department of Transfusion Medicine , National Institute of Immunohaematology, King Edward Memorial Hospital Campus , Parel , Mumbai , Maharashtra State , India
| | - Meenu Y Bohra
- a Department of Transfusion Medicine , National Institute of Immunohaematology, King Edward Memorial Hospital Campus , Parel , Mumbai , Maharashtra State , India
| | - Pratibha M Sawant
- a Department of Transfusion Medicine , National Institute of Immunohaematology, King Edward Memorial Hospital Campus , Parel , Mumbai , Maharashtra State , India
| | - Anita H Nadkarni
- a Department of Transfusion Medicine , National Institute of Immunohaematology, King Edward Memorial Hospital Campus , Parel , Mumbai , Maharashtra State , India
| | - Roshan B Colah
- a Department of Transfusion Medicine , National Institute of Immunohaematology, King Edward Memorial Hospital Campus , Parel , Mumbai , Maharashtra State , India
| | - Kanjaksha K Ghosh
- b Surat Raktadan Kendra, Udhna Khatodara Urban Health Centre , Near Chosath Joganio Mata Mandir , Surat , Gujarat State , India
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Abstract
The thalassemias and other inherited disorders of hemoglobin are likely to remain a serious global health problem for the foreseeable future. Currently, they are most frequent in the tropical belt; an assessment of their true frequency and the likely cost of management for the governments of these countries will require a form of micromapping. Over recent years, there has been major progress toward better prevention and management of the thalassemias in richer countries; it is likely that, using the tools of molecular genetics, they will eventually be completely curable, although this is probably a long time in the future.
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Affiliation(s)
- David J Weatherall
- University of Oxford, Weatherall Institute of Molecular Medicine, John Radcilffe Hospital, Headington, Oxford OX3 9DS, UK.
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Outcome of Pregnancy with Hemoglobinopathy in a Tertiary Care Center. J Obstet Gynaecol India 2018; 68:394-399. [PMID: 30224845 DOI: 10.1007/s13224-017-1073-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/28/2017] [Indexed: 10/18/2022] Open
Abstract
Purpose The objective was to observe the characteristics among pregnant patients with a diagnosed hemoglobinopathy and to study the obstetric and medical morbidity patterns during the antenatal and the perinatal periods in this group of patients. Methods A prospective observational study was conducted in a tertiary care center. Results Sixty patients were studied in 11 months. Primigravidae (43.3%) formed the highest percentage of patients. β Thalassemia trait was the most common hemoglobinopathy, seen in 81.66% of study subjects. The hemoglobin value ranged from 5.7 to 13.0, with an average of 9.2 g/dl. Thyroid problems were the most common associated medical disorder. Though IUGR and placenta previa were common, there were no major obstetric problems. There were 57 live births and 1 fresh stillbirth. Two patients had spontaneous abortion for which uterine curettage was done. LSCS was the most common obstetric outcome. Patients with sickle-cell disease required more blood transfusion than those with beta-thalassemia trait. There were 2 maternal mortalities, and both the patients were the diagnosed cases of sickle-cell disease. Conclusions While the perinatal outcomes among women with sickle-cell disease are poor, the outcomes in pregnant patients with beta-thalassemia trait were not a cause of major concern.
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Colah R, Italia K, Gorakshakar A. Burden of thalassemia in India: The road map for control. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2017. [DOI: 10.1016/j.phoj.2017.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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15
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Doro MG, Casu G, Frogheri L, Persico I, Triet LPM, Hoa PTT, Hoang NH, Pirastru M, Mereu P, Cucca F, Masala B. Molecular Characterization of β-Thalassemia Mutations in Central Vietnam. Hemoglobin 2017; 41:96-99. [DOI: 10.1080/03630269.2017.1321013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Maria G. Doro
- Institute of Research and Biomedical Genetics, National Research Council, Sassari, Italy
| | - Giuseppina Casu
- Institute of Research and Biomedical Genetics, National Research Council, Sassari, Italy
| | - Laura Frogheri
- Institute of Research and Biomedical Genetics, National Research Council, Sassari, Italy
| | - Ivana Persico
- Institute of Research and Biomedical Genetics, National Research Council, Sassari, Italy
| | - Le Phan Minh Triet
- Department of Hematology, Hue University of Medicine and Pharmacy, Hue, Vietnam
| | | | - Nguyen Huy Hoang
- Department of Hematology, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
| | - Monica Pirastru
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Paolo Mereu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Francesco Cucca
- Institute of Research and Biomedical Genetics, National Research Council, Sassari, Italy
| | - Bruno Masala
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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Koh DXR, Raja Sabudin RZA, Mohd Yusoff M, Hussin NH, Ahmad R, Othman A, Ismail E. Molecular Characterisation of α- and β-Thalassaemia among Indigenous Senoi Orang Asli Communities in Peninsular Malaysia. Ann Hum Genet 2017. [PMID: 28620953 DOI: 10.1111/ahg.12201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Thalassaemia is a public health problem in Malaysia, with each ethnic group having their own common mutations. However, there is a lack on data on the prevalence and common mutations among the indigenous people. This cross-sectional study was performed to determine the common mutations of α- and β-thalassaemia among the subethnic groups of Senoi, the largest Orang Asli group in Peninsular Malaysia. Blood samples collected from six Senoi subethnic groups were analysed for full blood count and haemoglobin analysis (HbAn). Samples with abnormal findings were then screened for α- and β-globin gene mutations. Out of the 752 samples collected, 255 showed abnormal HbAn results, and 122 cases showing abnormal red cell indices with normal HbAn findings were subjected to molecular screening. DNA analysis revealed a mixture of α- and β-globin gene mutations with 25 concomitant cases. The types of gene abnormalities detected for α-thalassaemia were termination codon (T>C) Hb CS (αCS α), Cd59 (G>A) haemoglobin Adana (Hb Adana) (αCd59 α), initiation codon (ATG>A-G) (αIniCd α), two-gene deletion (-SEA ), and single-gene 3.7-kb deletion (-α3.7 ). For β-thalassaemia, there were Cd26 (G>A) Hb E (βE ), Cd19 (A>G) Haemoglobin Malay (Hb Malay) (βCd19 ), and IVS 1-5 (G>C) (βIVS 1-5 ).
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Affiliation(s)
- Danny Xuan Rong Koh
- School of Biosciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Selangor, Malaysia
| | | | - Malisa Mohd Yusoff
- Department of Diagnostic Laboratory Services, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Noor Hamidah Hussin
- Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Rahimah Ahmad
- Haematology Unit, Cancer Research Centre, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Ainoon Othman
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Endom Ismail
- School of Biosciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Selangor, Malaysia
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Shah PS, Shah ND, Ray HSP, Khatri NB, Vaghasia KK, Raval RJ, Shah SC, Rao MV. Mutation analysis of β-thalassemia in East-Western Indian population: a recent molecular approach. APPLICATION OF CLINICAL GENETICS 2017; 10:27-35. [PMID: 28546763 PMCID: PMC5436775 DOI: 10.2147/tacg.s127531] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background β-Thalassemia is the most prevalent genetic disorder in India. Its traits and coinheritance vary from mild to severe conditions, resulting in thalassemia minor, intermediate, and major, depending upon many factors. Purpose The objective of this study was to identify the incidence of β-thalassemia traits, their coinheritance, and mutations, as well as to support the patients already diagnosed with β-thalassemia in East-Western Indian population for better management. Patients and methods Seventy-five referral cases for β-thalassemia were analyzed for various β-thalassemia traits, heterozygosity, and homozygosity conditions. Blood phenotypic parameters using cell counter and capillary electrophoresis were investigated. Analyses of eight common mutations of thalassemia in India were carried out using polymerase chain reaction-amplification refractory mutation system, end point polymerase chain reaction, and DNA sequencing methods. Results Of these (75) referral cases from East-Western Indian region, 68 were positive for β-thalassemia (90.67%). The majority of case types were of β-thalassemia minor (49, 65.33%), followed by HbE traits (6, 8.0%) and β-thalassemia major, including heterozygous and homozygous (5, 6.66%; 4, 5.33%) types and then HbE homozygous (2, 2.66%), as well as one each of the HbE/β-thalassemia and HbD/β-thalassemia (1, 1.34%) combination. Mutation analysis also revealed that the highest frequency of mutation was c.92+5G>C (41, 60.29%) followed by deletion 619bp (9, 13.23%) and c.79G>A (8, 11.76%) in our study group. Five cases (nos. 24, 27, 33, 58, and 71) exhibited coinheritance between β0/β+ (2), β0/β D (1), and c.124_127delTTCT/β+ or β0(2) affecting the Rajasthani and Gujarati populations in our study of the Western region of India. Conclusion We strongly recommend these Western populations for genetic screening before adopting reproductive technologies and interracial marital relations.
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Affiliation(s)
- Parth S Shah
- Department of Medicine, Lahey Hospital and Medical Center, Boston, MA
| | - Nidhi D Shah
- Department of Pediatrics, Nassau University Medical Centre, New York, NY, USA
| | | | | | | | | | - Sandip C Shah
- Supratech Micropath Laboratory and Research Institute
| | - Mandava V Rao
- School of Sciences, Gujarat University, Ahmedabad, Gujarat, India
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Panja A, Chowdhury P, Chakraborty S, Ghosh TK, Basu A. Cross-Sectional Study for the Detection of Mutations in the Beta-Globin Gene Among Patients with Hemoglobinopathies in the Bengali Population. Genet Test Mol Biomarkers 2017; 21:39-45. [DOI: 10.1089/gtmb.2016.0186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Amrita Panja
- Molecular Biology and Human Genetics Laboratory, Department of Zoology, The University of Burdwan, Burdwan, India
| | - Prosanto Chowdhury
- Peerless Hospital & B.K.Roy Research Centre, Burdwan Medical College and Hospital, Burdwan, India
| | | | - Tapan Kumar Ghosh
- Department of Pathology, Bankura Medical College and Hospital, Bankura, India
| | - Anupam Basu
- Molecular Biology and Human Genetics Laboratory, Department of Zoology, The University of Burdwan, Burdwan, India
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Premawardhena A, Allen A, Piel F, Fisher C, Perera L, Rodrigo R, Goonathilaka G, Ramees L, Peto T, Olivieri N, Weatherall D. The evolutionary and clinical implications of the uneven distribution of the frequency of the inherited haemoglobin variants over short geographical distances. Br J Haematol 2016; 176:475-484. [DOI: 10.1111/bjh.14437] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/23/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | - Angela Allen
- MRC Molecular Haematology Unit; MRC Weatherall Institute of Molecular Medicine; University of Oxford; Oxford United Kingdom
| | - Fred Piel
- Imperial College; London United Kingdom
| | - Chris Fisher
- MRC Molecular Haematology Unit; MRC Weatherall Institute of Molecular Medicine; University of Oxford; Oxford United Kingdom
| | | | | | | | | | - Tim Peto
- Nuffield Department of Clinical Medicine; University of Oxford; Oxford United Kingdom
| | | | - David Weatherall
- MRC Molecular Haematology Unit; MRC Weatherall Institute of Molecular Medicine; University of Oxford; Oxford United Kingdom
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Fucharoen S, Weatherall DJ. Progress Toward the Control and Management of the Thalassemias. Hematol Oncol Clin North Am 2016; 30:359-71. [DOI: 10.1016/j.hoc.2015.12.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thalassemia major and intermedia in jammu and kashmir, India: a regional transfusion centre experience. Indian J Hematol Blood Transfus 2014; 30:297-300. [PMID: 25435731 DOI: 10.1007/s12288-013-0301-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022] Open
Abstract
Data on status of thalassemia and hemoglobinopathies from the extreme northern part of India is scarce. We investigated socio-demographic characteristics and management issues related to β-thalassemia in Jammu and Kashmir, India. Data from 96 thalassemia major and intermedia patients visiting the department of transfusion medicine for their transfusion needs was collected. Parameters recorded included age group, age at diagnosis, gender, religion, districts of the state they belonged to, family history of thalassemia, blood group, type of thalassemia (major/intermedia), total number of transfusions received and chelation therapy status. Thalassemia major patients comprised 92 (95.8 %) and intermedia 4 (4.2 %) of the cohort. Most cases were diagnosed in infancy or early childhood. The districts of Jammu and Rajouri together contributed 53 % of the cases. Most patients were Hindu (76/96, 79.2 %). A positive family history was most often obtained from Muslim patients (8/18, 44.4 %). Only 50 % cases were on iron chelation therapy. There is a need to come up with a national/local policy to manage disease in endemic areas and a policy formulated to help families and patients. Data such as ours may help in health management planning for thalassemic patients in this region.
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Abstract
The β-thalassemias and sickle cell disorders pose a major health burden in the large and diverse Indian population. Education programs for awareness generation are being done by National Institutions, non-governmental organizations and Thalassemia Societies in different states. Several extensive epidemiological studies have shown that there are many non-tribal and tribal communities where the prevalence of b-thalassemia carriers is much higher (5.3 to 17.0%) than the average of 3 to 4% projected for the entire country. These variations have also been shown within small geographic regions in some states, emphasizing the need for micro mapping to estimate the true burden of disease. There are 10 to 12 centers where prenatal diagnosis for hemoglobinopathies is done and the Indian Council of Medical Research is establishing additional regional centers in states where they are most needed. Sixtyeight b-thalassemia mutations have been described so far among Indians and the knowledge on their prevalence and regional distribution has helped to undertake prenatal diagnosis in a cost effective way.
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Nagar R, Sinha S, Raman R. Haemoglobinopathies in eastern Indian states: a demographic evaluation. J Community Genet 2014; 6:1-8. [PMID: 25059538 DOI: 10.1007/s12687-014-0195-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 07/14/2014] [Indexed: 11/26/2022] Open
Abstract
Haemoglobinopathies are a leading cause of child mortality worldwide, although with a variable geographical incidence. A reliable estimate of prevalence of the disease is necessary for reducing its burden. However, most studies in India are either hospital based or from certain regions of the country and hence may not realistically reflect the disease burden. The eastern Indian states of Bihar, Chhattisgarh and Jharkhand and eastern region of Uttar Pradesh, which comprise ~25 % population of the country, are poorly studied with respect to haemoglobinopathies. The present study, conducted on 1,642 individuals from this region, shows a frequency of 3.4 % for β-thalassaemia trait (BTT), 3.4 % for sickle cell haemoglobin trait (HbS)/haemoglobin E trait (HbE) and 18 % for α-globin defects. While BTT mutations are distributed rather uniformly across the region, HbS occurs only in Chhattisgarh and Jharkhand, the regions rich in tribal populations. The frequency of α-gene mutation is strikingly high, occurring even in individuals with normal blood count, in tribal as well as non-tribal groups. The mutation spectrum of BTT is also distinct since the common mutations, IVS1-1 (G-T) and 619 bp del, are absent while CD15 (G-A) is the second most frequent. The HbA2 level in the suspected cases is strikingly low. We demonstrate association of the low HbA2 level with vitamin B12 and folate deficiency in this cohort. Thus, the present report besides providing an estimate of the carrier frequency of β-thalassaemia traits also confirms high prevalence of α-gene defects and regional heterogeneity in distribution of HbS in the eastern parts of India.
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Affiliation(s)
- Rachana Nagar
- Cytogenetics Laboratory, Department of Zoology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Christopher AF, Kumari A, Chaudhary S, Hora S, Ali Z, Agrawal SC. Unique pattern of mutations in β-thalassemia patients in Western Uttar Pradesh. INDIAN JOURNAL OF HUMAN GENETICS 2013; 19:207-12. [PMID: 24019624 PMCID: PMC3758729 DOI: 10.4103/0971-6866.116119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
CONTEXT β-thalassemia is one of the most common heterogeneous inherited single gene disorders. The disease results from one or more of 380 different mutations in the β-globin gene. Uttar Pradesh (U.P.) is the most populous state of India, comprising various ethnic groups and Bareilly is one of the largest cities situated in Western U.P. AIMS To examine the prevalence of five common β-thalassemian mutations: Intervening Sequence IVS 1-5 (c. 92 + 5 G > C), codon 8/9 (c. 27_28insG), codon 41/42 (c. 124_127delTTCT), IVS 1-1 (c. 92 + 1 G > T) and codon 26 G-A (c. 79G > A) in Western U.P. SETTINGS AND DESIGN Patients attending camps organized by the Thalassemia Society, Bareilly were selected for the study. MATERIALS AND METHODS A total of 48 blood samples were collected from the patients of transfusion dependent β-thalassemia from July 2011 to May 2012. All the samples were analyzed for five common mutations by using the Amplification Refractory Mutation System (ARMS)-hot start-polymerase chain reaction (PCR) technique. RESULTS Among the five common mutations prevalent in India, we were able to detect all except codon 26 G-A (c. 79G > A), which is prevalent in northeast India. These four mutations accounted for 58% of the total number of our patients. The IVS 1-5 (G-C) was found to be the most common mutation with a frequency of 46% and the 2 (nd)most common mutation was Fr8/9 (+G) with a frequency of 21%. The frequency of other mutations was IVS1-1 (12%) and Cd 41/42 (4%). CONCLUSION This study provides evidence that the pattern of mutations in Western U.P. is different from the rest of India and even from the neighboring states (Delhi and Punjab). To the best of our knowledge, mutation Fr8/9, the 2(nd)most common mutation in our study has never been reported to be so common from anywhere in India. Some mutations, which are prevalent in other regions are absent in our region (mutation for ε-globin). Hence, these findings can be called unique to Western U.P.
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Affiliation(s)
- Ajay F Christopher
- Central Research Laboratory, Department of Biochemistry, S.R.M.S. Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
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Weatherall DJ. The Role of the Inherited Disorders of Hemoglobin, the First “Molecular Diseases,” in the Future of Human Genetics. Annu Rev Genomics Hum Genet 2013; 14:1-24. [DOI: 10.1146/annurev-genom-091212-153500] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- David J. Weatherall
- Weatherall Institute of Molecular Medicine, Oxford University, John Radcliffe Hospital, Oxford OX3 9DS, United Kingdom;
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Molecular characterization of β-thalassemia in four communities in South Gujarat—codon 30 (G → A) a predominant mutation in the Kachhiya Patel community. Ann Hematol 2013; 92:1473-6. [DOI: 10.1007/s00277-013-1777-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 04/28/2013] [Indexed: 11/26/2022]
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Balarajan YS, Fawzi WW, Subramanian SV. Changing patterns of social inequalities in anaemia among women in India: cross-sectional study using nationally representative data. BMJ Open 2013; 3:bmjopen-2012-002233. [PMID: 23516270 PMCID: PMC3612779 DOI: 10.1136/bmjopen-2012-002233] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To examine the patterns of social inequalities in anaemia over time among women of reproductive age in India. DESIGN Repeated cross-sectional study using nationally representative data from the 1998/1999 and 2005/2006 National Family Health Surveys of India. Multivariate modified Poisson regression models were used to assess trends and social inequalities in anaemia. SETTING India. POPULATION 164 600 ever-married women aged 15-49 years (n=79 197 in 1998/1999 and n=85 403 in 2005/2006) from 25 Indian states. MAIN OUTCOME MEASURE Anaemia status defined by haemoglobin level (<12 g/dl in non-pregnant women, haemoglobin<11 g/dl for pregnant women). RESULTS Over the 7-year period, anaemia prevalence increased significantly from 51.3% (95% CI 50.6% to 52%) to 56.1% (95% CI 55.4% to 56.8%) among Indian women. This corresponded to a 1.11-fold increase in anaemia prevalence (95% CI 1.09 to 1.13) after adjustment for age and parity, and 1.08-fold increase (95% CI 1.06 to 1.10) after further adjustment for wealth, education and caste. There was marked state variation in anaemia prevalence; in only 4 of the 25 states did anaemia prevalence significantly decline. In both periods, anaemia was socially patterned, being positively associated with lower wealth status, lower education and belonging to scheduled tribes and scheduled castes. In this context of overall increasing anaemia prevalence, adjusted relative and absolute socioeconomic inequalities in anaemia by wealth, education and caste have narrowed significantly over time. CONCLUSIONS The significant increase in anaemia among India's women during this recent period is a matter of concern, and in contrast to secular improvements in other markers of women's health and nutritional status. While socioeconomic inequalities in anaemia persist, the relative and absolute inequalities in anaemia have decreased over time. Future research should explore the causes for these changing patterns, and inform the policy and programmatic response to address anaemia and its inequalities in this vulnerable population.
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Affiliation(s)
- Yarlini S Balarajan
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Wafaie W Fawzi
- Departments of Global Health and Population, Epidemiology and Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - S V Subramanian
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA
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Genetic Heterogeneity of Beta Globin Mutations among Asian-Indians and Importance in Genetic Counselling and Diagnosis. Mediterr J Hematol Infect Dis 2013; 5:e2013003. [PMID: 23350016 PMCID: PMC3552784 DOI: 10.4084/mjhid.2013.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 12/02/2012] [Indexed: 11/08/2022] Open
Abstract
There are an estimated 45 million carriers of β-thalassemia trait and about 12,000–15,000 infants with β-thalassemia major are born every year in India. Thalassemia major constitutes a significant burden on the health care system. The burden of thalassemia major can be decreased by premarital screening and prenatal diagnosis. The success of prenatal diagnosis requires proper knowledge of spectrum of β-thalassemia mutations. In present study, β-thalassemia mutations were characterized in 300 thalassemia cases from 2007 to 2010 using ARMS-PCR and DNA sequencing. The five most common mutations accounted 78.9% of the studied chromosomes that includes IVS1-5(G>C), Cod 41-42(-TCTT), Cod8-9(+G), Cod16(−C) and 619bp del. Though IVS1-5(G>C) is most common mutation in all the communities, the percentage prevalence were calculated on sub caste basis and found that IVS1-5(G>C) percentage prevalence varied from 25 to 60 in Aroras & Khatris and Thakur respectively. Interestingly Cod41-42(−TCTT) mutation which is the second commonest among the mutations reported was totally absent in Kayasthas and Muslim community. These findings have implications for providing molecular diagnosis, genetic counseling and prenatal diagnosis to high risk couples of β-thalassemia.
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Prevalence of β-thalassemia and other haemoglobinopathies in six cities in India: a multicentre study. J Community Genet 2012; 4:33-42. [PMID: 23086467 DOI: 10.1007/s12687-012-0114-0] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 07/26/2012] [Indexed: 10/27/2022] Open
Abstract
The population of India is extremely diverse comprising of more than 3,000 ethnic groups who still follow endogamy. Haemoglobinopathies are the commonest hereditary disorders in India and pose a major health problem. The data on the prevalence of β-thalassemias and other haemoglobinopathies in different caste/ethnic groups of India is scarce. Therefore the present multicentre study was undertaken in six cities of six states of India (Maharashtra, Gujarat, West Bengal, Assam, Karnataka and Punjab) to determine the prevalence of haemoglobinopathies in different caste/ethnic groups using uniform methodology. Fifty-six thousand seven hundred eighty individuals (college students and pregnant women) from different caste/ethnic groups were screened. RBC indices were measured on an automated haematology counter while the percentage of HbA(2), HbF and other abnormal Hb variants were estimated by HPLC on the Variant Hemoglobin Testing System. The overall prevalence of β-thalassemia trait was 2.78 % and varied from 1.48 to 3.64 % in different states, while the prevalence of β-thalassemia trait in 59 ethnic groups varied from 0 to 9.3 %. HbE trait was mainly seen in Dibrugarh in Assam (23.9 %) and Kolkata in West Bengal (3.92 %). In six ethnic groups from Assam, the prevalence of HbE trait varied from 41.1 to 66.7 %. Few subjects with δβ-thalassemia, HPFH, HbS trait, HbD trait, HbE homozygous and HbE β-thalassemia as well as HbS homozygous and HbS-β-thalassemia (<1 %) were also identified. This is the first large multicentre study covering cities from different regions of the country for screening for β-thalassemia carriers and other haemoglobinopathies where uniform protocols and methodology was followed and quality control ensured by the co-ordinating centre. This study also shows that establishment of centres for screening for β-thalassemia and other haemoglobinopathies is possible in medical colleges. Creating awareness, screening and counselling can be done at these centres. This experience will help to formulate a national thalassemia control programme in India.
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Kumar R, Sharma DC, Kishor P. Hb E/β-Thalassemia: The Second Most Common Cause of Transfusion-Dependent Thalassemia in the Gwalior-Chambal Region of Central India. Hemoglobin 2012; 36:485-90. [DOI: 10.3109/03630269.2012.699489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Verma IC, Saxena R, Kohli S. Hemoglobinopathies in India—Clinical and Laboratory Aspects. Clin Lab Med 2012; 32:249-62. [DOI: 10.1016/j.cll.2012.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Rios JJ, Shastry S, Jasso J, Hauser N, Garg A, Bensadoun A, Cohen JC, Hobbs HH. Deletion of GPIHBP1 causing severe chylomicronemia. J Inherit Metab Dis 2012; 35:531-40. [PMID: 22008945 PMCID: PMC3319888 DOI: 10.1007/s10545-011-9406-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/20/2011] [Accepted: 09/22/2011] [Indexed: 12/19/2022]
Abstract
Lipoprotein lipase (LPL) is a hydrolase that cleaves circulating triglycerides to release fatty acids to the surrounding tissues. The enzyme is synthesized in parenchymal cells and is transported to its site of action on the capillary endothelium by glycophosphatidylinositol (GPI)-anchored high-density lipoprotein-binding protein 1 (GPIHBP1). Inactivating mutations in LPL; in its cofactor, apolipoprotein (Apo) C2; or in GPIHBP1 cause severe hypertriglyceridemia. Here we describe an individual with complete deficiency of GPIHBP1. The proband was an Asian Indian boy who had severe chylomicronemia at 2 months of age. Array-based copy-number analysis of his genomic DNA revealed homozygosity for a 17.5-kb deletion that included GPIHBP1. A 44-year-old aunt with a history of hypertriglyceridemia and pancreatitis was also homozygous for the deletion. A bolus of intravenously administered heparin caused a rapid increase in circulating LPL and decreased plasma triglyceride levels in control individuals but not in two GPIHBP1-deficient patients. Thus, short-term treatment with heparin failed to attenuate the hypertriglyceridemia in patients with GPIHBP1 deficiency. The increasing resolution of copy number microarrays and their widespread adoption for routine cytogenetic analysis is likely to reveal a greater role for submicroscopic deletions in Mendelian conditions. We describe the first neonate with complete GPIHBP1 deficiency due to homozygosity for a deletion of GPIHBP1.
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Affiliation(s)
- Jonathan J. Rios
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Savitha Shastry
- Division of Nutrition and Metabolic Diseases, Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Juan Jasso
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Natalie Hauser
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Abhimanyu Garg
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
- Division of Nutrition and Metabolic Diseases, Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - André Bensadoun
- Division of Nutritional Sciences, Cornell University, Ithaca, NY USA
| | - Jonathan C. Cohen
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
- Division of Nutrition and Metabolic Diseases, Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Helen H. Hobbs
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
- Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, Dallas, TX USA
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Hardikar PS, Joshi SM, Bhat DS, Raut DA, Katre PA, Lubree HG, Jere A, Pandit AN, Fall CHD, Yajnik CS. Spuriously high prevalence of prediabetes diagnosed by HbA(1c) in young indians partly explained by hematological factors and iron deficiency anemia. Diabetes Care 2012; 35:797-802. [PMID: 22323413 PMCID: PMC3308281 DOI: 10.2337/dc11-1321] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the influence of glycemic and nonglycemic parameters on HbA(1c) concentrations in young adults, the majority of whom had normal glucose tolerance. RESEARCH DESIGN AND METHODS We compared the diagnosis of normal glucose tolerance, prediabetes, and diabetes between a standard oral glucose tolerance test (OGTT; World Health Organization 2006 criteria) and HbA(1c) concentrations (American Diabetes Association [ADA] 2009 criteria) in 116 young adults (average age 21.6 years) from the Pune Children's Study. We also studied the contribution of glycemic and nonglycemic determinants to HbA(1c) concentrations. RESULTS The OGTT showed that 7.8% of participants were prediabetic and 2.6% were diabetic. By ADA HbA(1c) criteria, 23.3% were prediabetic and 2.6% were diabetic. The negative predictive value of HbA(1c) was 93% and the positive predictive value was 20% (only 20% had prediabetes or diabetes according to the OGTT; this figure was 7% in anemic participants). Of participants, 34% were anemic, 37% were iron deficient (ferritin <15 ng/mL), 40% were vitamin B(12) deficient (<150 pmol/L), and 22% were folate deficient (<7 nmol/L). On multiple linear regression analysis, HbA(1c) was predicted by higher 2-h glucose (R(2) = 25.6%) and lower hemoglobin (R(2) = 7.7%). When hematological parameters were replaced by ferritin, vitamin B(12), and folate, HbA(1c) was predicted by higher glycemia (R(2) = 25.6%) and lower ferritin (R(2) = 4.3%). CONCLUSIONS The use of HbA(1c) to diagnose prediabetes and diabetes in iron-deficient populations may lead to a spuriously exaggerated prevalence. Further investigation is required before using HbA(1c) as a screening tool in nutritionally compromised populations.
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Affiliation(s)
- Pallavi S Hardikar
- Bajaj Diabetology Research Centre, King Edward Memorial Hospital Research Centre, Pune, India
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Chatterjee N, Mishra A, Soni R, Kulkarni H, Mamtani M, Shrivasatava M. Bayesian estimates of the prevalence of β-thalassemia trait in voluntary blood donors of central India: a survey. Hemoglobin 2011; 34:548-60. [PMID: 21077762 DOI: 10.3109/03630269.2010.526488] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Early detection of β-thalassemia (β-thal) trait is important. Voluntary blood donors represent an important group who are accessible and cooperative for this purpose. However, the usefulness of this population in β-thal trait detection programs has not been studied in India. We conducted a hematological survey of 5,045 blood donors who visited the Bhopal Memorial Hospital & Research Centre, Bhopal in central India. Using robust Bayesian methods, we estimated the prevalence of β-thal trait. The overall prevalence of β-thal trait in the study population was 9.59% [95% confidence interval (95% CI) 8.78-10.4%]. The prevalence of β-thal trait varied across the states of origin and within the state of Madhya Pradesh. We observed a cline effect for β-thal trait prevalence in relation to the latitude (p = 0.024). We conclude that blood donors offer an attractive adjunct to β-thal trait detection in national programs. Our study also offers insights into the β-thal trait gene flow and migration in India.
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Affiliation(s)
- Nirupama Chatterjee
- Thalassaemia Unit, Department of Transfusion Medicine, Bhopal Memorial Hospital & Research Centre, Karond, Raisen Bypass, Bhopal, India
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A descriptive profile of β-thalassaemia mutations in India, Pakistan and Sri Lanka. J Community Genet 2010; 1:149-57. [PMID: 22460247 DOI: 10.1007/s12687-010-0026-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 09/27/2010] [Indexed: 10/19/2022] Open
Abstract
Thalassaemia is a common and debilitating autosomal recessive disorder affecting many populations in South Asia. To date, efforts to create a regional profile of β-thalassaemia mutations have largely concentrated on the populations of India. The present study updates and expands an earlier profile of β-thalassaemia mutations in India, and incorporates comparable data from Pakistan and Sri Lanka. Despite limited data availability, clear patterns of historical and cultural population movements were observed relating to major β-thalassaemia mutations. The current regional mutation profiles of β-thalassaemia have been influenced by historical migrations into and from the Indian sub-continent, by the development and effects of Hindu, Buddhist, Muslim and Sikh religious traditions, and by the major mid-twentieth century population translocations that followed the Partition of India in 1947. Given the resultant genetic complexity revealed by the populations of India, Pakistan and Sri Lanka, to ensure optimum diagnostic efficiency and the delivery of appropriate care, it is important that screening and counselling programmes for β-thalassaemia mutations recognise the underlying patterns of population sub-division throughout the region.
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Weatherall DJ. Thalassemia as a global health problem: recent progress toward its control in the developing countries. Ann N Y Acad Sci 2010; 1202:17-23. [PMID: 20712767 DOI: 10.1111/j.1749-6632.2010.05546.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The thalassemias, together with sickle cell anemia and its variants, are by far the most common monogenic diseases. They occur at their highest frequency in countries of the developing world where their control and management is hampered by a lack of knowledge of their true prevalence, adequate services for their management and control, and support by their governments and international health agencies. However, there has been some progress recently in addressing these problems and there are several ways in which the lot of children with thalassemia in poor countries could be improved in the future. Over the last 20 years there has been considerable improvement in the control and management of the thalassemias in the richer countries of the world. Unfortunately, however, this is not the case for many of the developing countries, where there have been few improvements in the control of the numbers of births of babies with thalassemia or in the care of thalassemic children since the frequency of the problem started to become evident in the 1960s. Here, I will try to assess the current situation in these countries and examine some of the potential approaches for improving the current situation.
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Affiliation(s)
- D J Weatherall
- Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom.
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Weatherall DJ. The importance of micromapping the gene frequencies for the common inherited disorders of haemoglobin. Br J Haematol 2010; 149:635-7. [PMID: 20579050 DOI: 10.1111/j.1365-2141.2010.08118.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
It is estimated that in excess of 300,000 children are born each year with a severe inherited disorder of hemoglobin and that approximately 80% of these births occur in low- or middle-income countries. As these countries go through an epidemiologic transition, with a reduction in childhood and infant mortality due to improved public health measures, babies who would have previously died of these diseases before they were recognized are now surviving to present for diagnosis and treatment. Hence, they are presenting an increasing global health burden. Because of their uneven distribution in high-frequency populations, reflecting their complex population genetics, the true magnitude of this burden is still unknown. In many poor countries there are virtually no facilities for the diagnosis and management of these conditions, and even in richer countries there are limited data about their frequency, clinical course, or mortality. Without this information, it will be impossible to persuade governments about the increasing importance of these diseases. The situation will only be improved by concerted action on the part of the hematology community of the richer countries together with input from the major international health organizations and funding agencies.
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