Low Hemoglobin among Pregnant Women in Midwives Practice of Primary Health Care, Jatinangor, Indonesia: Iron Deficiency Anemia or β-Thalassemia Trait?

Abstract

Low hemoglobin (Hb) or anemia is common among pregnant women in developing countries which may cause adverse pregnancy outcomes and maternal deaths. Our study aimed to assess Hb level measured by midwives in primary health care facility at rural area of Jatinangor, Indonesia, and to explore whether the anemia was due to iron deficiency (IDA) or β-thalassemia trait (β-TT). Pregnant women (n = 105) had finger prick test for Hb level during a regular antenatal care examination from October to November 2016. Hb level by finger prick test was compared with venous blood, measured by complete blood count (CBC). Indices including MCV and MCH and indices of Shine & Lal, Mentzer, Srivastava, Engels & Frase, Ehsani, and Sirdah were analyzed to differentiate anemia due to IDA and anemia due to suspect β-TT. HbA2 was measured to confirm β-TT. Anemic pregnant women were found in 86.7% by finger prick test compared to 21.9% (n = 23) by CBC. The prevalence of β-TT in our study was 5.7%. Hb measurement among pregnant women in low resource area is highly important; however, finger prick test in this study showed a high frequency of anemia which may lead to iron oversupplementation. A standard CBC is encouraged; MCV and MCH would help midwives to identify β-TT.

Shine & Lal index as a predictor for early detection of β-thalassemia carriers in a limited resource area in Bandung, Indonesia

“…Interestingly, anaemia is only prevalent in 57.1 and 25.9% of β-thalassemia carrier IVS1nt5 (c92 + 5G > C) and HbE (c.79G > A) variants, respectively, indicating that most individuals have normal Hb or are non-anaemic, though they have low SLI. SLI has thus been proven to be a valid discriminating index to distinguish between IDA and β-thalassemia [14], as also shown in our previous study [15]. …”

Association of Colecalciferol, Ferritin, and Anemia among Pregnant Women: Result from Cohort Study on Vitamin D Status and Its Impact during Pregnancy and Childhood in Indonesia

“…Studies also reported that maternal anemia is associated with fetal and neonatal well-being [ 11 – 13 ]. The latest study on anemia among pregnant women in Jatinangor-West Java was as high as 21.9% [ 14 ].…”

Association between sickle cell and β-thalassemia genes and hemoglobin concentration and anemia in children and non-pregnant women in Sierra Leone: ancillary analysis of data from Sierra Leone’s 2013 National Micronutrient Survey

“…Similar to sickle cell, the prevalence of β-thalassemia among children and women in our study was notably higher that the prevalence found in other studies. Mockenhaupt et al [ 11 ] found heterozygous β-thalassemia in 1% of pregnant women enrolled in a cross-sectional study in Ghana Two studies from the 1970’s in Nigeria found a β-thalassemia prevalence of < 1% [ 12 ]; however, in a small clinic-based study in Nigeria, Vincent et al [ 13 ] found that 6% of adults possessed both sickle cell and β-thalassemia genes. A similar prevalence of β-thalassemia has been observed in Pakistan (5–8%, [ 14 ]) and Indonesia (6%, [ 13 ]).…”