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Preventable Severe Thalassemia among Children
Chaiwat Rerkswattavorn1,2, Nongnuch Sirachainan1, Duantida Songdej1
1a Department of Pediatrics , Faculty of Medicine Ramathibodi Hospital, Mahidol University , Bangkok , Thailand.
Insights
Preventable severe thalassemia cases in children can be reduced through accurate prenatal diagnosis (PND) and increased parental awareness. Addressing medical errors and parental knowledge gaps is crucial for effective thalassemia prevention strategies.
Area of Science:
- Medical Genetics
- Public Health
- Reproductive Medicine
Background:
- Severe thalassemia presents a significant public health challenge, particularly in at-risk populations.
- Preventable cases highlight deficiencies in current screening and diagnostic protocols.
- Understanding parental decision-making is vital for improving thalassemia prevention.
Purpose of the Study:
- To analyze factors contributing to preventable severe thalassemia cases in children.
- To evaluate the impact of prenatal diagnosis (PND) on thalassemia prevention.
- To identify barriers and facilitators in PND uptake among at-risk couples.
Main Methods:
- Retrospective analysis of 27 children with severe thalassemia born to 24 at-risk couples (1997-2017).
- Categorization into prenatal diagnosis (PND) and non-PND groups.
- Review of medical records and parental counseling outcomes.
Main Results:
- Medical errors (misdiagnosis, missed PND opportunities) and parental ignorance were significant factors in the non-PND group.
- Parental decisions regarding PND were influenced by knowledge, beliefs, religion, thalassemia experience, and fetal sex.
- A notable divorce rate (20.8%) was observed in the studied couples.
Conclusions:
- Effective thalassemia prevention requires both informed parental decision-making and accurate medical services.
- Enhancing carrier detection and PND accessibility is essential.
- Public health initiatives should focus on education regarding the consequences of severe thalassemia.
Abstract:
This retrospective study analyzed 27 children with preventable severe thalassemia born to 24 at-risk couples between 1997 and 2017. The couples were categorized into two groups: the prenatal diagnosis (PND) group (n = 8) and the non PND group (n = 16). In the PND group, following comprehensive counseling on having a fetus with thalassemia, six couples decided to continue the pregnancy (n = 6). Termination of the two remaining fetuses was excluded as the thalassemia status was reported at a gestational age of 24 weeks. In the non PND group, medical errors were found in the misdiagnosis of couples as non thalassemia carriers (n = 4) and not offering PND to couples with known thalassemia carrier status when attending the antenatal clinic (ANC) (n = 2). Additionally, parental ignorance was found in parents experiencing their own thalassemia, or that of their spouse or child (n = 6). The remaining couples (n = 4) with known carrier status either directly refused PND or were ineligible for it. A total of five divorces (5/24 = 20.8%) occurred in the PND (n = 2) and the non PND (n = 3) groups. Knowledge, beliefs, religion, experience of thalassemia, as well as the sex of the at-risk fetus all influenced parental decisions. Therefore, both medical personnel and parents are key in preventing new cases of thalassemia. Parents should be aware of the consequences of having children with severe thalassemia, while medical personnel should provide accurate carrier detection and PND.
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