NESTROFT—A Cost-Effective Mass Screening Tool for the Detection of β-Thalassemia Carrier Status in Anemic Pregnant Women: A Step Toward Reducing the National Disease Burden
Introduction β-Thalassemias are inherited hemoglobinopathies commonly encountered in practice. With chances of a promising cure being rare, the prevention of births with this disorder should assume priority, especially in low-resource countries. This can be achieved by the implementation of a mass screening program that is reliable and, at the same time, cost-effective.
Objectives This study focuses on the utility of Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT) as a mass screening tool to detect thalassemia carriers. Hematological parameters that may predict carrier status were also evaluated.
Materials and Methods Hemoglobin estimation was performed on all consented pregnant women. If the patient was found to have hemoglobin < 11 g/dL, the blood sample was subjected to other routine hematological tests along with peripheral smear examination. NESTROFT was performed using 0.36% saline solution. Confirmation was done using high-performance liquid chromatography (HPLC).
Statistical Analysis Data obtained were tabulated using version 21 of the Statistical Package for Social Sciences. Means, standard deviations, and percentages were used to describe the sample. Chi-square test and Students’ t test were used to identify differences between the groups.
Results Of 441 pregnant women enrolled, 206 were found to be anemic. Nineteen (9.2%) of the anemic pregnant women were detected to be carriers of hemoglobinopathies. Among the hematological parameters, mean red blood cell count and reticulocyte count were higher, while mean corpuscular hemoglobin concentration was lower in carriers. Also, carriers were more likely to present with microcytic hypochromic anemia. NESTROFT showed a sensitivity of 84.21%, specificity of 96.25%, a positive predictive value of 69.56%, and a negative predictive value of 98.36%. A false-positive result was seen in 3.74% of the tests, while a false negative result was seen in 15.78% of the tests.
Conclusions NESTROFT (0.36%) can be used as a simple and cost-effective mass screening tool for the detection of carrier status. This should be followed by confirmation using HPLC or hemoglobin electrophoresis.
Artikel online veröffentlicht:
09. Juli 2021
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- 1 Mulchandani DV, Fulare MB, Zodpey SP, Vasudeo ND. Prevalence and some epidemiological factors of beta thalassaemia trait in Sindhi community of Nagpur City, India. Indian J Public Health 2008; 52 (01) 11-15 [published correction appears in Indian J Public Health. 2008 Jan-Mar;52(1):following 52]
- 2 Piplani S, Manan R, Lalit M, Manjari M, Bhasin T, Bawa J. NESTROFT - A valuable, cost effective screening test for beta thalassemia trait in North Indian Punjabi population. J Clin Diagn Res 2013; 7 (12) 2784-687
- 3 Patel P, Sarda N, Arora R, Gaikwad HS. Comparative evaluation of NESTROFT and RDW as screening tests for beta thalassemia trait in pregnancy. Int J Reprod Contracept Obstet Gynecol 2015; 4 (02) 424-428
- 4 Tim RR. Thalassemia. In: McKenzie SB, Williams JL, eds. Clinical Laboratory Hematology. 2nd edition. New York: Pearson 2009: 231-256
- 5 Rakholia R, Chaturvedi P. Prevalence of β thalassemia carrier state in Sindhi community of Wardha and evaluation of risk factors for β thalassemia trait. Niger J Clin Pract 2013; 16 (03) 375-380
- 6 Kulkarni P, Masthi NR, Niveditha S, Suvarna R. The prevalence of the beta thalassemia trait among the pregnant women who attended the ANC clinic in a PHC, by using the NESTROF test in Bangalore, Karnataka. J Clin Diagn Res 2013; 7 (07) 1414-1417
- 7 Mamtani M, Das K, Jawahirani A, Rughwani V, Kulkarni H. Is NESTROFT sufficient for mass screening for beta-thalassaemia trait?. J Med Screen 2007; 14 (04) 169-173
- 8 Baxi A, Manila K, Kadhi P, Heena B. Carrier screening for β thalassemia in pregnant Indian women: experience at a single center in Madhya Pradesh. Indian J Hematol Blood Transfus 2013; 29 (02) 71-74
- 9 Colah RB. The use of NESTROFT for screening pregnant women for detection of β-thalassemia carriers. J Foetal Med 2015; 2: 9-10
- 10 Singh SP, Gupta SC. Effectiveness of red cell osmotic fragility test with varying degrees of saline concentration in detecting beta-thalassaemia trait. Singapore Med J 2008; 49 (10) 823-826
- 11 Chakrabarti I, Sinha SK, Ghosh N, Goswami BK. Beta thalassemia carrier detection by NESTROFT: an answer in rural scenario?. Iran J Pathol 2012; 7 (01) 19-26
- 12 Vijay B, Gupta S, Gupta R. Detection of carriers for β-thalassemia: a case study of Jammu (J&K. Orient J Chem 2010; 26 (01) 199-206
- 13 Sirichotiyakul S, Tantipalakorn C, Sanguansermsri T, Wanapirak C, Tongsong T. Erythrocyte osmotic fragility test for screening of alpha-thalassemia-1 and beta-thalassemia trait in pregnancy. Int J Gynaecol Obstet 2004; 86 (03) 347-350
- 14 Tyagi S, Dass J, Sharma M. Diagnosis of thalassemia and hemoglobinopathies. In: Agarwal MB, ed. Haematology Today. Mumbai: Agarwal Publisher 2010: 91-101
- 15 Lafferty JD, Crowther MA, Ali MA, Levine M. The evaluation of various mathematical RBC indices and their efficacy in discriminating between thalassemic and non-thalassemic microcytosis. Am J Clin Pathol 1996; 106 (02) 201-205
- 16 Sumera A, Ahmed S, Ali MA, Khanani R. Evaluation of NESTROFT as a marker of differentiation between β-thalassemia trait & iron deficiency anemia. Int J Collab Res Intern Med Public Health 2012; 4: 1560-1566