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scientific articles

Screening for sickle cell and thalassaemia in primary care: a cost-effectiveness study

key information

source: British Journal of General Practice

year: 2012

authors: Erskine J


Better schemes for providing screening for sickle cell and sickle diseases are to be commended. However, I am concerned that the article by Bryan et al1 is based too heavily upon a cultural paradigm that is white, Anglo-Saxon, agnostic, and pro-choice. This is revealed by the early statement implying that screening later than 10 weeks will be ‘too late to make reproductive choices’.

In many Mediterranean and Asian cultures, the first and most important reproductive choice is to get married, and this very often happens a long time before conception. The intent thereafter is to have children, not whether to do so. Screening after that point can generally be regarded as too late within the framework of this article, in which the flow chart and commentary seem to be looking at screening for, and probable termination of, affected pregnancies.

A greater concern for many ‘traditionally minded’ cultures, in which the concept of termination is not happily entertained, would perhaps be to identify support available to the parents and future children. An increased rate of pregnancy loss, following on from earlier antenatal screening and consequent chorionic villus sampling, may be seen in such situations as counterproductive.

Later diagnosis would be less risky to the child (and less costly) and still allow ample time for preparation for child care, that may involve technologies such as infant bone marrow transplantation to minimise ongoing childhood and adult illness.

The first step must surely be to decide whether the screening is to eradicate babies with these haemogobinopathies or to provide support to the future parents of affected children.

An even better screening programme may be offered before marriage, thus truly allowing the reproductive choice suggested by this article! This approach has been taken in some Asian communities in High Wycombe, and perhaps elsewhere.

DOI: 10.3399/bjgp12X616265

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