Pre-natal diagnosis of thalassaemia in Sri Lanka: A ten year review

Abstract

Thalassaemia is the commonest monogenic disease in Sri Lanka, affecting over 3500 children and half-a-million thalassaemia carriers. This is a review of 82 amniocenteses performed from 2006 to 2016, in the largest prenatal diagnoses study for thalassaemia carried out in Sri Lanka. Amniocenteses were performed between 11 and 12 weeks of ultrasonically confirmed gestation, on mothers with previous thalassaemia major children pregnant for the second time and nulliparous thalassaemia trait women married to trait partners. The Consultant Radiologist, using local analgesia, under ultrasound cover, performed these as an outpatient procedure, at the Teaching Hospital Kandy & Suwasevana Hospital Kandy. The amniotic fluid was analysed by the team of Senior Geneticists, at the Genetech Molecular Diagnostics and School of Gene Technology, Colombo, via the polymerase-chain-reaction based ARMS (Amplification Refractory Mutation Systems) assay. The genetic results indicated the presence of 21% thalassaemia major foetuses, 53% thalassaemia traits and 26% foetuses without thalassaemia mutations. The predominance of the IVS1-5(G-C) mutation in the Sri Lankan population is exemplified, with a low prevalence of HbE thalassaemia.

Impact statement

• Thalassaemia is the commonest monogenic disease in Sri Lanka affecting over 3500 children and half-a-million thalassaemia carriers. Although pre-natal diagnosis by amniocentesis was practised universally for many years, this could not be performed in Sri Lanka as genetic diagnostic facilities were not available until 2005. Therefore, parents with a thalassaemia major child limited their families to one child, by choice or by termination.

• The results of this study point to a 21% probability of thalassaemia major in the next child, giving the parents a guarded optimism to conceive another child without thalassaemia disease. With siblings being the highest HLA compatibility for Bone Marrow Transplant, that is now being established in Sri Lanka as a permanent cure for thalassaemia, this will bring a ray of hope for these desperate parents to finally cure their previous sick child.

• Although, 95% of the Sri Lankan mutated genetic sites for thalassaemia are known, more research will be needed to identify the other rare sites. The publication of this paper, with its novelty for pre-natal diagnosis, would encourage clinicians to practice it in other centres and to extend it to families with other genetic disorders.

Keywords:

• Thalassaemia
• amniocentesis
• mutation
• carrier

Acknowledgements

We wish to acknowledge the assistance of the ‘Lanka Thalassaemia Circle’, the parent body related to the wellbeing of the Thalassaemia children in Sri Lanka, for their patronage.

Disclosure statement

There are no financial (patent ownership, stock ownership, consultancies, speaker’s fees, shares), personal, political, intellectual (organizing education) or religious interests by any of the authors.

Details of ethics approval

Prior approval to collect these data and to publish was obtained from the Director, Teaching Hospital Kandy, Sri Lanka (on 20th June 2008) and Chief Executive Officer, Suwasevana Hospital Kandy, Sri Lanka (on 15th May 2016) Ref. No. SH/Con/KKN/001.

Funding

There was no funding of any type from either a commercial company, charity or government department towards the preparation of this article.