Beta-Thalassemia Carrier Detection by NESTROFT: An Answer in Rural Scenario?

Background and Objectives: Beta-thalassemia continues to be a cause of significant burden to the society particularly in the poorer developing countries. Although sophisticated methods of screening have become available, a hunt for a cheap, rapid, objective screening method still remains elusive. Thus, the objectives are to study the validity of Naked-Eye-Single-Tube-Osmotic- Fragility-Test (NESTROFT) in detection of beta-thalassemia carrier state, to assess the prevalence of beta-thalassemia trait among antenatal mothers in the region and also to find out the effect of concurrent iron deficiency on the hematological parameters in these cases. Materials and Methods: A total of 500 antenatal mothers in a rural tertiary care hospital were selected for the study. Their blood samples were subjected to NESTROFT, complete hemogram, reticulocyte counts and hemoglobin variant studies by electrophoresis and by high pressure liquid chromatography (HPLC). Serum ferritin estimation was done in cases diagnosed as beta-thalassemia trait. The results were analyzed statistically. Results: A prevalence of 3.4% of beta-thalassemia trait and 0.6% of E-beta-thalassemia were observed among the study population. NESTROFT showed an overall sensitivity and specificity of 95% and 95.8% respectively in detection of heterozygous and double heterozygous states of beta-thalassemia. The various RBC indices were significantly (P < 0.05) lower in carriers with concurrent iron deficiency. A co-existent iron deficiency did not preclude a diagnosis of betathalassemia carrier state. Conclusions: NESTROFT appears to a valid test in rural setting with financial constraints. The hematological parameters in iron deficient beta-thalassemic carriers significantly differed from their iron replete counterparts but did not cause problem in diagnoses.