การเปรียบเทียบประสิทธิภาพของวิธีการตรวจกรองพาหะของ ธาลัสซีเมีย: ข้อบ่งใช้ในการศึกษาความชุกของโรคธาลัสซีเมีย พาหะของแอลฟ่า-ธาลัสซีเมีย 1และเบต้า-ธาลัสซีเมียในนักเรียนมัธยมปลายในจังหวัดนครศรีธรรมราช

บทคัดย่อ

AbstractComparison of efficiency of screening tests for thalassemia carriers: implication forprevalence study of thalassemic disease, alpha-thalassemia1and beta-thalassemia carriers in highschool students in Nakhon Si ThammaratWe studied anemia and the prevalence of thalassemia disease, alpha – thalassemia1and beta- thalassemia carriers 3 high schools with a total of 1137 students in thasala in district,Nakhon si thammarat province. Cross – sectional survey in 1137 students were deter mined withstandardized diagnostic protocals and WHO criteria of anemia [ Hemoglobin ( Hb < 12 g/dl infemales and Hb < 13 g/dl in males ) ]. RBC analysis, the red cell discriminant functionincorporating RDW ; DF (DF. = MCV2x RDW / Hb x 100 ) , modified Osmotic fragility( OF ) test, modified dichlorophenolindophenol ( DCIP ) test, Hemoglobin typing, serum ferritinmeasurement and DNA analysis for ?-Thalassemia 1 (SEA deletion) trait were performed.Of the 1137 blood samples tested, 306 ( 26.91 % ) had microcytosis ( mean corpuscular volume,< 80 fl ), 192 ( 16.89% ) had anemias and 39 ( 3.43 % ) had iron deficiency anemia, IDA.One hundred ninety-four students ( 17.06 % ) were in the group of thalassemia andhemoglobinopathies, of whom 18 ( 1.58 % ) were carriers of the Southeast Asian type of deletion,in which both ? -globin genes on the same chromosome 16 are deletion (?-Thalassemia 1 ).One student was a carrier of ?-Thalassemia 1 and hereditary persistence of fetal hemoglobin( HPFH ). Five students were of ?-Thalassemia 1 and Hb E. Twenty – eight ( 2.46 % ) werecarrier of ?-Thalassemia. One hundred fourty-eight ( 13.02 % ) students were carrier of Hb Eand Eleven ( 0.97 % ) students were HPFH. IDA and thalassemia trait were two of the mostcommon causes of microcytic anemias worldwide. Because of similar blood picture, it wasimperative to differentiate and correctlty diagnose these two anemias. Taking DF values of aboveand below 75% as indicative of IDA and thalassemia traits, respectively, we identified correctlyabout 90% of subjects in thalassemia traits and about 79% of subjects in IDA. The DCIP testdetected all Hb E carriers with a sensitivity and specificity of 100%. The combination of OF test,DCIP test and DF values should be useful and applicable to differentiate IDA from thalassemiatrait in population screening programs for thalassemia and hemoglobinopathies in community withlimited facilities and economic resourcse.

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