Anaemia among females in child-bearing age: Relative contributions, effects and interactions of α- and β-thalassaemia

Introduction Anaemia in women during pregnancy and child bearing age is one of the most common global health problems. Reasons are numerous, but in many cases only minimal attempts are made to elucidate the underlying causes. In this study we aim to identify aetiology of anaemia in women of child bearing age and to determine the relative contributions, effects and interactions of alpha- and beta-thalassaemia in a region of the world where thalassaemia is endemic. Methods A cross sectional study was conducted at the Colombo North Teaching Hospital of Sri Lanka. The patient database of deliveries between January 2015 and September 2016 at University Obstetrics Unit was screened to identify women with anaemia during pregnancy and 253 anaemic females were randomly re-called for the study. Data were collected using an interviewer-administered questionnaire and haematological investigations were done to identify aetiologies. Results Out of the 253 females who were anaemic during pregnancy and were re-called, 8 were excluded due to being currently pregnant. Of the remaining 245 females, 117(47.8%) remained anaemic and another 22(9.0%) had non-anaemic microcytosis. Of anaemic females, 28(24.8%) were iron deficient, 40(35.4%) had low-normal serum ferritin without fulfilling the criteria for iron deficiency,18(15.3%) had beta-haemoglobinopathy trait and 20 (17.0%) had alpha-thalassaemia trait. Of females who had non-anaemic microcytosis, 14 (66.0%) had alpha-thalassaemia trait. In 4 females, both alpha- and beta-thalassaemia trait coexist. These females had higher levels of haemoglobin (p = 0.06), MCV (p<0.05) and MCH (p<0.01) compared to individuals with only beta-thalassaemia trait. A significantly higher proportion of premature births (p<0.01) and lower mean birth weights (p<0.05) were observed in patients with alpha-thalassaemia trait. Conclusions Nearly one third of anaemic females in child bearing age had thalassaemia trait of which alpha-thalassemia contributes to a majority. Both alpha- and beta-thalassaemia trait can co-exist and have ameliorating effects on red cell indices in heterozygous states. alpha-Thalassaemia trait was significantly associated with premature births and low birth weight. It is of paramount importance to investigate the causes of anaemia in women of child bearing age and during pregnancy in addition to providing universal iron supplementation.