Hematological Disorders in Afghanistan: A Review

Afghanistan faces a heavy and largely under‑recognized burden of hematological disorders, shaped by a uniquely complex interplay of high consanguinity, population‑specific genetic variants, widespread nutritional deficiencies, extreme environmental conditions, and decades of armed conflict. The national consanguinity rate (~ 46%) drives some of the world's highest prevalences of autosomal recessive hemoglobinopathies, particularly β‑thalassemia, with 1-1.5 million estimated carriers. β‑thalassemia carrier rates vary sharply by ethnicity, reaching 5-10% in Pashtun and Tajik groups, while the α‑globin novel mutation Hb Balkh has been identified in the central highlands of Aghaninstan. G6PD deficiency, predominantly the Mediterranean type, affects up to 8.9% of Pashtun males and make a barrier to cure malaria with primaquine. Nutritional anemias are equally pervasive: anemia affects 51% of pregnant women in some provinces, 44.2% of children under five have iron deficiency, and 25% of newly arrived Afghan refugees have vitamin B12 deficiency. Conflict aggravates every dimension of the hematologic disease burden trauma‑induced coagulopathy, a largely voluntary blood supply with transfusion‑transmissible infection markers in 4.36% of donations (HBV 2.95%, HCV 0.81%), and the near‑absence of newborn screening, HPLC, or molecular diagnostics. Management relies on splenectomy and irregular transfusions; premarital screening is not mandated. This review synthesizes peer‑reviewed evidence (2000-2026) to provide the first comprehensive narrative of hematological disorders in Afghanistan, critically appraises diagnostic and therapeutic gaps against regional standards, and proposes a pragmatic research and intervention agenda.

Geographic and thematic overview of hematological disorders in Afghanistan. The map of Afghanistan and neighboring countries (Turkmenistan, Tajikistan, China, Iran, Pakistan) highlights key drivers and disease hotspots. Major contributing factors include: (i) high consanguinity rates and genetic disorders (β thalassemia, hemoglobinopathies, G6PD deficiency); (ii) environmental pollution and toxic exposures; (iii) conflict, war instability, and poor healthcare infrastructure; and (iv) rare blood disorders. The convergence of these factors creates distinct hematological disease hotspots across the country, with Pashtun and Tajik populations showing higher thalassemia carrier rates and conflict-affected regions facing diagnostic and treatment gaps.