Thalassemia in Pakistan: A forward-looking solution to a serious health issue

Zaheer, Hasan Abbas; Waheed, Usman; Abdella, Yetmgeta; Konings, Frank

doi:10.4103/gjtm.gjtm_72_19

Cited by 26 publications

(21 citation statements)

References 7 publications

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“…14 About 5% 15 of the population is heterozygous for beta-globin gene (thalassemia minor) and the number of patients with thalassemia major is estimated to be 100,000. 16 However, as no baseline survey has ever been conducted, the exact burden of the disease is unknown. 16 Thalassemia incidence is seeing an upward trend despite being a preventable disease, attributed mainly to the absence of a national strategy.…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis on the Epidemiology of Hepatitis B and Hepatitis C Virus among Beta-Thalassemia Major Patients in Pakistan

Waheed

Saba²,

Wazeer

et al. 2021

J Lab Physicians

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Beta-thalassemia major patients are the leading consumers of blood transfusions in Pakistan and, therefore, have a greater risk of acquiring transfusion-transmitted infections, most notably hepatitis B and C virus (HBV and HCV). The present study includes a comprehensive review on the status of HBV and HCV in beta-thalassemia major patients in Pakistan. For this purpose, we examined original articles assessing the epidemiology of HBV and HCV in transfusion-dependent thalassemia patients.We searched 10 major subscription databases from January through February 2020, that is, Medline, PakMediNet, CINAHL, Scopus, PubMed, Web of Science, Embase, Science Direct, Google Scholar, and Directory of Open Access Journals. The World Health Organization resources were also explored for relevant reports. The search criteria included published articles up to December 31, 2019, with no language restrictions. Articles identified were introduced into the Endnote version X9 software and then screened for relevance and duplication. The results were stated as the pooled prevalence for the overall study and also for region-wise subgroups.A total of 33 studies conducted from 1995 to 2019 were included in the review. All 33 articles yielded information on HCV prevalence, while 19 of them provided information on HBV prevalence. The overall sample size was 8,554 that tested the prevalence of HCV in thalassemia patients. The sample size from the 19 studies that tested the prevalence of HBV was 6,184. The overall pooled prevalence of HBV was computed to be 4.13%, while the pooled prevalence of HCV was 29.79%. The majority of the studies were obtained from the Punjab Province (33.33%), followed by Khyber Pakhtunkhwa Province (24.24%).The total sample size of 33 studies was less than 10% of the total number of estimated thalassemic patients, that is, 100,000. Further studies or a national baseline survey are imperative to confirm the actual frequency of HBV and HCV in thalassemia patients across the country.

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Section: Introductionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis on the Epidemiology of Hepatitis B and Hepatitis C Virus among Beta-Thalassemia Major Patients in Pakistan

Waheed

Saba²,

Wazeer

et al. 2021

J Lab Physicians

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“…It is expounding at the pace of 5000 youngsters each year. 1,4 Amongst the different blood transfusion based risks, the blood-borne viruses, for example, Hepatitis B and C viruses are the commonest infectious agents transmitted via a transfusion. 1 HCV is liable for approximately 80 to 90% of hepatitis following transfusion.…”

Section: Introductionmentioning

confidence: 99%

“…It is probably owing to the wide occurrence of the defective alpha-beta chain gene, cousin marriages and high nationwide birth rate. 1,4 The predominance of viral hepatitis manifestations in thalassemic patients is associated with the infection in the donor. Consequently, the prohibition of blood-borne viral transmission continues to be a key obsession for transfusion administrations overall.…”

Section: Introductionmentioning

confidence: 99%

Frequency of Thalassemia and Its Association with Hepatitis C Infection in Local Population of Pakistan

Khan¹,

Reyaz²,

Baloch³

et al. 2020

BIOMEDICA

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Background and Objective: Thalassemia major or βeta-thalassemia is a hereditary blood disorder, necessitating continuous blood transfusions. Frequent blood transfusions often result in the development of hepatitis, hepatocellular carcinoma, acquired immunodeficiency syndrome (AIDS) and many other infectious diseases. Incidence of infection of viral hepatitis in thalassemia patients is majorly associated with infections in the donor population. The objective of this study was to ascertain the frequency of HCV infection in patients with thalassemia in Pakistan.Methods: This study was conducted from January 2015 to September 2018 in various sections of Punjab and Sindh, Pakistan. A total number of 439 patients were enrolled in this study, samples of blood from the patients were collected and their Anti-HCV antibodies were evaluated by enzyme-linked immunosorbent assay (ELISA); HCV-RNA genome presentation was assessed by HCV-nested-real time-polymerase chain reaction (RT-PCR) for the confirmation.Results: It was found that major population of the thalassemia patients were male (63%). While the female thalassemia population was almost twice in Sindh province as compared to Punjab. In present study, n = 187 were detected positive among those n = 168 were confirmed by PCR. Only 47% thalassemia patients were found vaccinated against hepatitis B whereas all HCV positive patients were not vaccinated, and (84.96%) thalassemia patients were from the family of first cousin marriage. The patients which are not vaccinated also had significant chance to acquire the viral infection (P < 0.001). Moreover there could be some gender and environmental or geographical factors associated with thalassemia that are yet to be explored in detail. Conclusion:Thalassemia patients carry major risk for acquiring transfusion associated infection.

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“…With a population of 220 million inhabitants and high ratio of consanguineous marriages, Pakistan is among the highest thalassaemia burden countries around the globe with 100,000 transfusion-dependent thalassaemia patients in the country. [ 4 ] Thalassaemia patients require a regular supply of blood and blood components to sustain life. These multi-transfused patients are dependent on regular transfusions, so more prone to acquire transfusion-transmitted infections most notably HBV and HCV.…”

Section: Introductionmentioning

confidence: 99%

Molecular and genetic characterization of hepatitis B virus among multitransfused thalassaemia patients in Islamabad, Pakistan

Ahmad

Waheed

Saba

et al. 2021

Journal of Family Medicine and Primary Care

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Background: Hepatitis B virus (HBV) is the aetiological agent of transfusion-transmitted hepatitis globally. Beta thalassaemia major individuals are at greater risk of contracting HBV infection due to multiple blood transfusions required for the medical management of these patients. Based on HBV genetic variability, it is divided into 10 genotypes. The determination of HBV genotypes has significant implications for clinical management and treatment regimens. Aim: This study was performed to assess the HBV epidemiology and circulating genotypes in multi-transfused β-thalassemia major patients with the aim to be considered while formulating the treatment pattern taking into account particular needs of thalassaemia patients. Materials and Methods: This study was performed from September 2018 to June 2019, at the Department of Pathology and Transfusion Medicine, Shaheed Zulfiqar Ali Bhutto (SZAB) Medical University, Islamabad. A total of 2,260 thalassaemia patients were enrolled in the study. The study was endorsed by the Ethics Committee of the SZAB Medical University, Islamabad. The samples were serologically screened for HBsAg on the LIAISON® XL Murex HBsAg Quant assay (DiaSorin S.p.A., Italy) a chemiluminescence based immunoassay (CLIA). HBV quantitative PCR kit was used to measure the HBV DNA in serum samples. The HBV genotypes were determined using universal primers targeting the P1 and S1 region amplification. Results: Of 2,260 thalassaemia patients, 64.6% were males while 35.4% were females. The HBsAg was identified in 98 individuals (4.33%). The PCR analysis was done for these 98 patients and in this cohort, genotype D was 59.18% ( n = 58), genotype A was 21.42% ( n = 21) while genotype C was 19.38% ( n = 19). Conclusion: The determination of HBV genotypes in the multi-transfused patients is key to the effective management of chronic HBV patients as the severity and course of the disease is dependent on a specific type of genotypes. Quality assured screening of donated blood will prevent the incidence of HBV in thalassaemia patients.

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Thalassemia in Pakistan: A forward-looking solution to a serious health issue

Cited by 26 publications

References 7 publications

A Systematic Review and Meta-Analysis on the Epidemiology of Hepatitis B and Hepatitis C Virus among Beta-Thalassemia Major Patients in Pakistan

A Systematic Review and Meta-Analysis on the Epidemiology of Hepatitis B and Hepatitis C Virus among Beta-Thalassemia Major Patients in Pakistan

Frequency of Thalassemia and Its Association with Hepatitis C Infection in Local Population of Pakistan

Molecular and genetic characterization of hepatitis B virus among multitransfused thalassaemia patients in Islamabad, Pakistan

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