title: The effects of economic sanctions on disease specific clinical outcomes of patients with thalassemia and hemophilia in Iran.
abstract: BACKGROUND
  The sanctions applied by both the USA and the EU against Iran do not formally ban the exports of medicines; in practice, however, patients are experiencing great difficulty in securing the treatment. This article documents the impact of international sanctions on patients with thalassemia and hemophilia in southern Iran.
  
  
  METHODS
  This survey examined the specific effects of external sanctions on the access of patients to their treatment between 2009 and 2012 from the point of view of patients with thalassemia (n=69) and congenital coagulation disorders (n=40) as well as related physicians (n=20). Also, clinical manifestation and laboratory data of patients were compared in the same period.
  
  
  RESULTS
  Access to deferoxamine and Exjade as iron chelators in patients with thalasseamia, respectively, declined by almost 70% and half over this period. In addition, access to lyophilized coagulation factor VIII concentrate in hemophilia A dramatically dropped from 96.7% in 2009 to 3.3% in 2012. The clinical results showed a significant deterioration of arthropathy (P<0.001) in hemophiliac patients and a significant increase in serum ferritin levels in thalassemia patients (P=0.036).
  
  
  CONCLUSIONS
  Sanctions had significant effect on public health on patients with thalassemia and hemophilia.
authors.affiliation: Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: karimim@sums.ac.ir.
authors.forename: Mehran
authors.initials: M
authors.lastname: Karimi
authors.affiliation: Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Sezaneh
authors.initials: S
authors.lastname: Haghpanah
mesh_terms: D000293:Adolescent; D000328:Adult; D001565:Benzoates / Q000600:supply & distribution / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D000077588:Deferasirox; D003676:Deferoxamine / Q000600:supply & distribution / Q000627:therapeutic use; D005260:Female; D005293:Ferritins / Q000097:blood; D006304:Health Status; D006467:Hemophilia A / Q000188:drug therapy; D006801:Humans; D038622:Internationality; D007492:Iran; D008297:Male; D010949:Plasma; D011795:Surveys and Questionnaires; D013789:Thalassemia / Q000188:drug therapy*; D014230:Triazoles / Q000600:supply & distribution / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D001565:Benzoates; D014230:Triazoles; D005293:Ferritins; D003676:Deferoxamine; D000077588:Deferasirox
keywords: Sanctions; Shortage of medicine; Thalassemia