Anaemia among females in child-bearing age: Relative contributions, effects and interactions of α- and β-thalassaemia

Abstract

IntroductionAnaemia in women during pregnancy and child bearing age is one of the most common global health problems. Reasons are numerous, but in many cases only minimal attempts are made to elucidate the underlying causes. In this study we aim to identify aetiology of anaemia in women of child bearing age and to determine the relative contributions, effects and interactions of α- and β-thalassaemia in a region of the world where thalassaemia is endemic.MethodsA cross sectional study was conducted at the Colombo North Teaching Hospital of Sri Lanka. The patient database of deliveries between January 2015 and September 2016 at University Obstetrics Unit was screened to identify women with anaemia during pregnancy and 253 anaemic females were randomly re-called for the study. Data were collected using an interviewer-administered questionnaire and haematological investigations were done to identify aetiologies.ResultsOut of the 253 females who were anaemic during pregnancy and were re-called, 8 were excluded due to being currently pregnant. Of the remaining 245 females, 117(47.8%) remained anaemic and another 22(9.0%) had non-anaemic microcytosis. Of anaemic females, 28(24.8%) were iron deficient, 40(35.4%) had low-normal serum ferritin without fulfilling the criteria for iron deficiency,18(15.3%) had β-haemoglobinopathy trait and 20(17.0%) had α-thalassaemia trait. Of females who had non-anaemic microcytosis, 14(66.0%) had α-thalassaemia trait. In 4 females, both α- and β-thalassaemia trait coexist. These females had higher levels of haemoglobin (p = 0.06), MCV (p<0.05) and MCH (p<0.01) compared to individuals with only β-thalassaemia trait. A significantly higher proportion of premature births (p<0.01) and lower mean birth weights (p<0.05) were observed in patients with α-thalassaemia trait.ConclusionsNearly one third of anaemic females in child bearing age had thalassaemia trait of which α-thalassemia contributes to a majority. Both α- and β-thalassaemia trait can co-exist and have ameliorating effects on red cell indices in heterozygous states. α-Thalassaemia trait was significantly associated with premature births and low birth weight. It is of paramount importance to investigate the causes of anaemia in women of child bearing age and during pregnancy in addition to providing universal iron supplementation.

Iron Deficiency and Iron Deficiency Anemia: Implications and Impact in Pregnancy, Fetal Development, and Early Childhood Parameters

“…Anemia is a major contributor to maternal and fetal morbidity and mortality, particularly in less developed countries [2][3][4][5][6]. Of the pathologic causes of anemia in pregnancy, anemia due to iron deficiency (IDA) is the most common, particularly in more developed countries, where contributions from other anemia-producing disorders such as malaria or hemoglobinopathies are less significant [7][8][9].…”

Health related quality of life among children with transfusion dependent β-thalassaemia major and haemoglobin E β-thalassaemia in Sri Lanka: a case control study

“…This is believed to be due to the selective advantage among carriers of β-thalassaemia against Plasmodium falciparum malaria which was highly prevalent in these regions [14]. Sri Lanka is a South Asian country located within the tropical thalassaemia belt [15]. The gene frequency of β-thalassaemia in Sri Lanka is 2.8% and approximately 2000 patients with TDBT are being treated in thalassaemia centres across the country [16].…”

Clinical and laboratory evaluation of childhood anaemia

“…10 . Similarly, iron deficiency can coexist with -or thalassaemia 11 . Therefore, considering the importance of prevention of -thalassaemia, it is important to investigate for -thalassaemia trait even if a diagnosis of iron deficiency is made in a child with microcytic anaemia 12,13 .…”