Preventing the birth of new cases is considered the best
approach for controlling thalassemia for which screening for
thalassemia carriers is mandatory. Thalassemia screening can be
either voluntary or mandatory, before or after the marriage, and
before or after the pregnancy. Several countries like Cyprus, Iran,
Saudi Arabia and Palestinian territories have adopted mandatory
screening achieving almost 100% coverage. Other countries
have adopted voluntary screening in accordance with the WHO
mandate [8]. In all countries thalassemia screening has contributed
for reduced incidence of beta thalassemia and carrier screening is
an essential intervention in all these preventive programs [5,6,9].
Screening of entire populations, high-risk populations, extended
families, school children, pregnant mothers and couples before
marriage have been carried out as each local situation warranted
[5,6]. A policy of voluntary screening of school leavers’ has been
adopted. The screening relies on MCV and MCH performed by
an automated haematological analyzer. Those with MCV above
80 fl and MCH above 27pg are considered non-carriers and a
green card would be given. A qualified medical officer would
treat those with MCV less than 80fl and MCH less than 27pg with
iron after a comprehensive clinical evaluation. Recovery of MCV
and MCH in repeat test also would be given a green card. Others
with persistent MCV values below 80fl and MCH values below
27pg would be referred for HPLC to confirm thalassemia carrier
state and they would be given a red card. Results of the blood
test would be communicated to people with health education
and counseling using the thalassemia porondoma which is a
pictorial depiction of the risks of range of combinations of pairs
in a proposed couple