title: The pros and cons of the fourth revision of thalassaemia screening programme in Iran.
abstract: Objective To evaluate the repercussions of recent changes to the cut-offs used in the first screening step of the pre-marital screening programme for thalassaemia prevention in Iran. Methods The profiles of 984 subjects referred to a genetic laboratory, and the tests of 242 parents of children with thalassaemia major were assessed for red blood cell (RBC) indices, haemoglobin (Hb) A2 levels and results of Hb electrophoresis. Results Of 407 suspected thalassaemia minor (STM) cases, 18 proved positive for thalassaemia minor on molecular analysis (18/407, confidence interval 2.6-6.9%). If the revised screening cut-offs had been used to determine who would undergo molecular analysis, two of these cases would not have been identified. Only 4.4% of suspected cases with lower than normal RBC indices (mean corpuscular volume <80 fl and mean corpuscular Hb <27 pg) and HbA2 (<3.5%) were diagnosed with thalassaemia minor. Conclusion The thalassaemia major prevention programme is performed in two separate steps. One step involves the screening of subjects and identification of β-thalassaemia minor, suspected cases for thalassaemia minor (STM), and normal subject groups. The other step concerns the identification of thalassaemia minor in the STM group. Changing the cut-offs at the first screening step does not result in significant improvement from an economic view, and is associated with significant risk at the second screening step.
authors.affiliation: 1 Department of Pediatric Hematology-Oncology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Moafi
authors.affiliation: 2 Sayed Al-shohada Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Reihaneh
authors.initials: R
authors.lastname: Vallian
authors.affiliation: 3 Divisions of Genetics, Department of Biology, University of Isfahan, Isfahan, Iran.
authors.forename: Sadeq
authors.initials: S
authors.lastname: Vallian
authors.affiliation: 4 Divisions of Cellular and Molecular Biology, Department of Biology, University of Isfahan, Isfahan, Iran.
authors.forename: Soheila
authors.initials: S
authors.lastname: Rahgozar
authors.affiliation: 2 Sayed Al-shohada Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Torfenajad
authors.affiliation: 5 Department of Biology, Faculty of Science, University of British Columbia, Vancouver, Canada.
authors.forename: Hadi
authors.initials: H
authors.lastname: Moafi
mesh_terms: D000328:Adult; D002648:Child; D005260:Female; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007492:Iran; D008297:Male; D008403:Mass Screening / Q000592:standards*; D011291:Premarital Examinations; D058996:Quality Improvement; D012189:Retrospective Studies; D013789:Thalassemia / Q000097:blood / Q000235:genetics / Q000517:prevention & control*
keywords: Beta-thalassaemia; pre-marital screening; prenatal diagnosis; red blood cell indices