Prenatal prevention for severe thalassemia disease at Srinagarind Hospital.
OBJECTIVE
To evaluate the results and cost-effectiveness of prenatal prevention measurement in severe thalassemia diseases at Srinagarind Hospital.


METHODS
Descriptive study.


METHODS
Antenatal care (ANC) Clinic, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University.


METHODS
1,498 thalassemic screened pregnant women first presenting at ANC Clinic at gestational age less than 17 weeks.


METHODS
Medical records of thalassemic screened pregnant women between February 2002 and February 2005 were analyzed. Those with a value of mean corpuscular volume (MCV) less than 80 fl, or positive dichlorophenol indophenol precipitation test (KKU-DCIP Clear Reagent Kit) underwent hemoglobin (Hb) typing by high performance liquid chromatography (HPLC) together with thalassemia investigation (complete blood count, MCV and Hb typing) of their husbands and to identify couples at risk of 3 severe thalassemia diseases; Hb Bart's hydrops fetalis, homozygous, -thalassemia and, -thalassemia/ Hb E disease. Then they were advised to undergo DNA analysis and, if they had fetal risk, appropriate prenatal diagnosis was offered.


METHODS
Number of affected fetuses detected by prenatal diagnosis.


RESULTS
Nine hundred and ninety six pregnant women (66.49%) were positive on screening. Of these, 642 (64.46%) had thalassemia investigation done with their spouses. There were 19 couples at risk (1.27% of total screened pregnant women) for having fetal severe thalassemia disease from initial laboratory results. Most of them were, -thalassemia/ Hb E diseases. We found only 10 pregnant women (52.63%) that had undergone prenatal diagnosis. The consequent results were two affected fetuses (20%), one was Hb Bart's hydrops fetalis, and the other was, o-thalassemia/ Hb E disease. In these cases, their parents decided to discontinue the pregnancy. Our prevention program could save 1.14 million bahts for the cost of treatment in two prevented severe thalassemia cases.


CONCLUSIONS
The prenatal prevention program of severe thalassemia disease at Srinagarind Hospital can effectively detect affected fetuses and reduce severe thalassemia disease, which is a major health problem in Thailand.
Ratanasiri
Thawalwong
T
Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
Charoenthong
Chutharat
C
Komwilaisak
Ratana
R
Changtrakul
Yotsombat
Y
Fucharoen
Supan
S
Wongkham
Jamras
J
Kleebkaow
Pilaiwan
P
Seejorn
Kanok
K
D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000191:economics; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics*; D011296:Prenatal Diagnosis; D015397:Program Evaluation; D018570:Risk Assessment; D013785:Thailand; D013789:Thalassemia / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control*