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Query: UMLS:C0019045 (hemoglobinopathies)
 2,704 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Prenatal diagnosis of the hemoglobinopathies has been increasingly reported. This article discusses those ethical issues stemming from pregnancy studies by fetoscopy or placental aspiration: diagnostic accuracy and safety for mother and fetus, abortion of the fetus diagnosed as homozygous for thalassemia or sickle cell diseases, and access to prenatal diagnosis for those who cannot afford it. The author's position on these issues attempts to mediate between the poles in current ethical debate on abortion in public policy.
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PMID:Prenatal diagnosis of the hemoglobinopathies: ethical issues. 47 61

531 chorionic villi forceps biopsies were carried out, to look for genetic diseases. Sampling was impossible in 24 cases (4.5%). The following indications were chosen: maternal age over 38 years: 361 cases; parental chromosome abnormality: 28 cases; previous history of chromosome abnormality: 21 cases; X-linked disease: 77 cases; metabolic disease: 32 cases; hemoglobinopathy: 7 cases; blood group determination: 5 cases. An elective abortion was carried out in 44 cases (8.7%), whereas 465 pregnancies were not interrupted. Full term has been reached in 327 pregnancies. The rate of miscarriage in this group is 3.9% (13 miscarriages out of 327 pregnancies followed). The results obtained at the Saint-Vincent-de-Paul Hospital show that the cytogenetic technique is reliable, and that the low risk of sampling allows its application in the diagnosis of chromosome anomalies.
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PMID:[Chorionic villi sampling. Results with the first 500 samples]. 273 22

A retrospective study of 35 HbSS and 15 HbSC pregnant patients was undertaken to illustrate the hazards to both mother and child of gestations associated with these hemoglobinopathies. It was found that these patients experienced a 10% to 14% maternal mortality rate and a 51% to 55% perinatal mortality rate. The fact that the mother, due to her illness, cannot care for the child, coupled with the poor medical health that the offspring themselves have if they too inherit the homozygous gene, provides additional support to the concept that some form of relief should be offered these women. Based on the figures of this study and those of others, aggressive genetic counseling to the women is advocated including liberal surgical sterilization and primary abortion in certain cases.
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PMID:Counseling the patient with sickle cell disease about reproduction: pregnancy outcome does not justify the maternal risk. 509 51

Isoelectric focusing (IEF) of hemoglobin was compared to the classical chromatography of labeled globin chains for 22 antenatal diagnoses of hemoglobinopathies: 11 for beta thalassemia, and 11 for sickle cell disease. In all cases, the two methods gave identical results. The diagnosis was confirmed after birth or abortion. Three fetuses homozygous for beta thalassemia and one homozygous for sickle cell disease exhibited no Hb A by IEF, in contrast to normal fetuses or those heterozygous for one of the two hemoglobinopathies. In addition, blood samples obtained in other centers after abortion of 22 fetuses homozygous for beta + or beta 0 thalassemia exhibited no Hb A when analyzed by IEF. When Hb A was present, the respective proportions of Hb A and acetylated Hb F were determined by densitometry of the IEF gel. The Hb A/acetylated Hb F ratio obtained by IEF correlated well with the beta A/gamma ratio of globin chain synthesis, IEF requires 0.1 mg of unlabeled hemoglobin. It is performed in 90 min and several samples can be analyzed simultaneously. If present, maternal contamination of fetal blood must be eliminated by selective lysis of maternal (RBC) using the Orskov reaction. Improvements in this method to obtain suitable samples for IEF analysis are described.
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PMID:Prenatal diagnosis of hemoglobinopathies: comparison of the results obtained by isoelectric focusing of hemoglobins and by chromatography of radioactive globin chains. 615 34

Two new techniques have been devised for the prenatal diagnosis of hemoglobinopathies performed on fetal blood samples. Isoelectric focusing (IEF) of hemoglobins was compared to the classical chromatography of labelled globin chains for 51 fetal blood samples, 40 being obtained for prenatal diagnosis of hemoglobinopathies, in Paris. In all cases the two methods provided identical results. Adult hemoglobin was quantitatively evaluated. In addition blood samples obtained in other centers after abortion of 22 fetuses homozygous for beta thalassemia did not exhibited measureable amounts of Hb A by IEF. The fetal blood must be free of maternal contamination. If present maternal red blood cells can be completely eliminated by selective lysis using the 0RSKOV reaction. A chromatography of hemoglobins on Biorex 70 has been devised very recently to overcome the two limitations of IEF: First the contamination of fetal blood samples by maternal cells, and second the impossibility to evaluate Hb A when present in proportion below 1%. The chromatography of hemoglobins on Biorex 70 is performed in 75 minutes with 0.1 mg of hemoglobin present in membrane free hemolysate. The optical density recording allows to evaluate .5% of Hb A and to detect .1% of Hb A. In addition, the radioactivity profile of the chromatography can be determined. It has to be used in case of maternal contamination.
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PMID:New techniques for the prenatal diagnosis of hemoglobinopathies. 617 72

New reproductive genetics means recently developed techniques to prevent the birth of children with specific defects or genetic diseases by testing individuals for sickle cell anemia, the thalassemias, Tay-Sachs disease, cystic fibrosis, or Down syndrome. Third World health services have many deficiencies with high maternal mortality rates (30-40 fold higher than in developed countries), the low percentage of births delivered by health personnel, the high rates of low birth weight babies, and high child malnutrition and infant mortality rates. The main issues in women's reproductive health are fertility regulation, abortion, maternal mortality, sexually transmitted diseases, and infertility. As a result of expansion in contraceptive use worldwide, the total fertility rate in developing countries has declined from 6.1 in 1965 to 3.9 in 1990. It is estimated that, worldwide, 36-53 million induced abortions are performed each year, most of them in developing nations. WHO estimates that more than 500,000 women die each year because of complications of pregnancy, most in developing countries. More than 95% of the 13 million estimated deaths of children under 5 years of age have occurred in these countries. Approximately 200 million people carry a potentially pathologic hemoglobinopathy gene, and about 250,000 children are born every year with hemoglobinopathy, most of them in the developing world. Reproductive genetic testing in big cities and in private for-profit ventures cater to the socioeconomic elite. Amniocentesis is often misused for fetal sex determination to abort female fetuses in India. Currently, in Cuba virtually every pregnant woman is tested for sickle cell trait and maternal serum alpha-fetoprotein levels between 15 and 20 weeks of gestation. It is predicted that the judicious use of reproductive genetic testing will be possible when health and quality of life issues are addressed properly.
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PMID:Reproductive health and genetic testing in the Third World. 840

Prenatal diagnosis is available for pregnancies at risk for virtually all inherited disorders of hemoglobin production. The field of reproductive genetics must confront many ethical, legal, and social concerns regarding its use, many of which derive from a woman's desire to bear children but legal right to abortion. The goal of more widespread utilization of prenatal diagnosis is sought in the context of questioning the ethical control to be exerted over the biological makeup of future generations. Its appropriate application would be facilitated greatly by the availability of reliable DNA markers of disease severity. Advances in fetal sampling and in detecting mutant globin genes have provided the safe, accurate methodology required for prenatal diagnosis. Chorionic villus sampling in the first trimester has become standard practice, but second trimester amniocentesis also is used for sampling fetal DNA. The use of preimplantation diagnosis and testing fetal cells from the maternal circulation will soon be practical. DNA-based detection of globin gene mutations has been facilitated greatly by the polymerase chain reaction revolution, and several reliable diagnostic methods are available. Polymerase chain reaction-based methods rely on restriction analysis, allele-specific hybridization or amplification, DNA sequence analysis, and new non-polymerase chain reaction methods for DNA amplification in vitro. These methods are available for detecting hemoglobinopathy, thalassemia, and thalassemic-hemoglobinopathy genes that affect alpha- or beta-globin loci.
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PMID:Advances in the prenatal and molecular diagnosis of the hemoglobinopathies and thalassemias. 853 29

Hemoglobinopathies are common inherited disorders in Saudi Arabia. Prenatal diagnosis for such diseases is specific and sensitive but not yet implemented in Saudi Arabia. Saudis are Muslims with a very high rate of consanguinity and inherited genetic disorders. To examine the attitude of Saudi families affected with hemoglobinopathies towards prenatal diagnosis and abortion, and to evaluate the effect of education on religious ruling on such attitudes, 32 families were interviewed using a pre-structured questionnaire. The majority accepted prenatal diagnosis (81.3%). The attitude towards abortion was greatly affected by religious values. Education about religious ruling significantly affected parents' attitude towards accepting abortion and prenatal diagnosis. No other factors were found to influence the outcome. Although the majority of families received some kind of formal genetic counseling [23/32 (71.9%)], none of them was informed about the possibility of prenatal or preimplantation diagnosis prior to the interview. Therefore for prevention of genetic disorders, the emphasis in countries with a vast majority of Muslims such as Saudi Arabia has probably to be placed on public awareness about genetic risks, the risk of consanguinity, availability of services, and so on, while at the same time taking into consideration the religious beliefs and education of the target population
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PMID:Attitude of Saudi families affected with hemoglobinopathies towards prenatal screening and abortion and the influence of religious ruling (Fatwa). 1143 47

Haemoglobinopathies are a group of genetic disorders which are particularly prevalent among certain risk groups such as ethnic groups. Antenatal screening of potential haemoglobinopathy carriers allows early diagnosis for affected fetuses, leading to therapeutic intervention or termination. However, it has drawbacks such as screening costs and possible miscarriage as a result of fetal testing. This paper describes a model that allows the outcomes of a screening programme to be estimated for different risk groups. The model has been implemented as a computer package that can be used to inform decisions made by health care planners.
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PMID:A stochastic model to evaluate options for antenatal genetic screening. 1689 7

Hereditary hemoglobinopathies should be considered as differential diagnosis when examining placental specimens for fetal growth retardation and spontaneous abortion. They can cause various macroscopic and microscopic changes in the placenta that are relevant for routine pathology examination. The importance of interdisciplinary co-operation between obstetrics and pathology to achieve optimum diagnostics and therapy planning is demonstrated using the case of a pregnant woman with heterozygous genotype and her child with homozygous genotype. Within this context, the influence of hemoglobinopathies on placental pathology and fetal development are summarized and exemplified.
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PMID:[Sickle cell anemia in perinatal placental diagnostics]. 1925 11


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