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Can Couples With MCV≥80, MCH<26, HbA2<3.2, HbF<3 be Classified as Low-risk β-Thalassemia Group?

Mirzakhani, Mohsen MSc*; Tarrahi, Mohammad J. PhD*; Baghersad, Atefe MD; Maracy, Mohammad R. PhD*

Journal of Pediatric Hematology/Oncology: May 2019 - Volume 41 - Issue 4 - p 303–306
doi: 10.1097/MPH.0000000000001423
Original Articles

Background and Aim: Thalassemia screening instructions in Iran categorizes couples with mean corpuscular volume (MCV)=75 to 80, mean corpuscular hemoglobin (MCH)=26 to 27, hemoglobin A2 (HbA2)<3.5, and hemoglobin fetal (HbF)<3 indices as low-risk couples, and therefore further genetic testing is not obligatory. This study examined the possibility of classifying couples with MCH<26 and MCV≥80 indices in the low-risk group when their HbF was <3 and HbA2 was <3.2.

Methodology: This was a cross-sectional study. The data included results from cell blood count and HbA2 prenatal diagnosis (PND) and HbF tests taken by 22 health care centers in Esfahan province, central Iran, throughout the years 2012-2016. The inclusion criterion was the registering of MCV, MCH, and PND results of the participants. From the 5804 participants, 5624 individuals were included in the study.

Results: The sensitivity and specificity of the screening program were 99.7 and 53.12, respectively. Ten cases (0.18%) with thalassemia trait had indices MCV≥80 and MCH≥26 including 3 cases (0.05%) with concurrent α and β-thalassemia mutations and 7 cases (0.12%) with HbS mutations. Altogether, 553 subjects (9.83%) had MCV≥80 and MCH<26 indices, and only 1 case (0.018%) was found with β-thalassemia mutations (codon8 (-AA)/WT genotype).

Conclusions: Subjects with MCV≥80, MCH<26, HbA2<3.2, and HbF<3 cell blood count indices could be grouped as low-risk couples if normal HbA2 and HbF values are considered. The results of this study also indicate that there is a chance of missing concurrent α and β-thalassemia or HbS hemoglobinopathies in the current screening program given the fact that genetic testing is not considered for couples with MCV and MCH in the low-risk range. HbF testing could be conducted to prevent these missing cases.

*Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan

Department of Genetics, Diseases Control Center, Ministry of Health and Medical Education, Tehran, Iran

The authors declare no conflict of interest.

Reprints: Mohammad R. Maracy, PhD, Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran 81746-73461 (e-mail:

Received May 24, 2018

Accepted November 22, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.