Would you recognize the hemoglobin abnormalities of immigrants?
Would you recognize
the hemoglobin abnormalities of immigrants?
The increasing number of immigrants in Finland is evident in laboratories as well. Immigration poses challenges for hematology laboratories in particular, because certain hemoglobin abnormalities which have been rare in Finland are common among certain groups of immigrants.
Päivi Helminen-Pacius, Senior Physician at the Huslab laboratory enterprise, made a presentation at the Laboratory Medicine event concerning two groups of inherited hemoglobin abnormalities that are found almost exclusively among immigrants. The abnormalities are very rare among the Finnish population and therefore may go unidentified in Finland.
African and Asian origins
Inherited hemoglobin abnormalities are divided into thalassemias (a.k.a. Mediterranean anemia) and hemoglobin variants. In thalassemias, the structure of globin chains is normal, but their production is affected. In hemoglobin variants, the structure of the globin molecule is abnormal.
Annually, approximately 330,000 children are born with a thalassemia or a sickle cell anemia. Thalassemias are prevalent in West Africa, South-East and South Asia and in the Mediterranean region. Variant sickle cell syndromes are found in western Africa and in South Asia.
In thalassemias defective globin genes lead to an imbalance of globin chains. A minor imbalance has no considerable effect, but when production of hemoglobin is affected, the hemoglobin level sinks. The body compensates for the reduced level of hemoglobin by increasing production of red blood cells, which causes changes in blood count, damage to erythrocyte membranes and hemolytic anemia.
Thalassemias have traditionally been divided into minor, intermediate and major forms according to the severity of symptoms, which depends on how many damaged or missing genes the patient has.
– Today, people with thalassemias are classified according to blood transfusion dependency, which emphasizes the severity of the condition.
In severe cases, iron overload can damage organs, and therefore it is essential to differentiate thalassemia from ordinary iron deficiency anemia.
Hemoglobin variants cause different hemolytic conditions, of which sickle-cell diseases are usually severe.
Sickled red blood cells block small blood vessels and may damage organs. Symptoms of sickle cell diseases often become apparent already during infancy.
Identification at health care centers
In Finland, we have not had a unified policy on diagnosing and treating these abnormalities.
– In Finland, diagnosing immigrants’ blood abnormalities is in its infancy.
Now is the time to react. In Finland, hemoglobin abnormalities are usually taken for iron deficiency anemia, but negligently prescribing iron tablets to a thalassemia patient may lead to accumulation of iron and severe damage to the organs.
– Now that there is more immigration from areas where these inherited hemoglobin abnormalities are common, it is important to differentiate between different hemoglobin abnormalities at health care centers as well.
Text and photo: Hanna Hyvärinen
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