European Journal of Pediatrics

, Volume 169, Issue 11, pp 1317–1322 | Cite as

Thalassemia and iron deficiency in a group of northeast Thai school children: relationship to the occurrence of anemia

  • Nichathorn Panomai
  • Kanokwan Sanchaisuriya
  • Supawadee Yamsri
  • Pattara Sanchaisuriya
  • Goonnapa Fucharoen
  • Supan Fucharoen
  • Frank P. Schelp
Original Paper


The cross-sectional study assessed anemia, thalassemia, and hemoglobinopathies, as well as iron deficiency, among 190 northeastern Thai school children aged 10 to 11 years. The aim was to analyze the reasons for anemia among the group. Hemoglobin concentration and other hematological parameters were determined using an automated blood cell counter. Beta-thalassemia and other hemoglobinopathies were identified by high performance liquid chromatography (HPLC) analysis of hemoglobin. Alpha-thalassemia was identified by polymerase chain reaction (PCR) and related techniques. Iron deficiency was assessed using serum ferritin (SF) <20 ng/ml as indicator. Based on the WHO criteria, anemia was defined by hemoglobin (Hb) level <11.5 g/dl. Twenty five out of 190 children (13.2%; 95% CI = 8.7–18.8%) were anemic. Iron deficiency was found in only two out of 190 children (1.0%; 95% CI = 0.1–3.8%), but the two iron deficient children were not anemic. The proportion of thalassemia and hemoglobinopathies among the group was 61.1% (95% CI = 53.7–68.0%). As underlying reasons for anemia, thalassemia and hemoglobinopathies were found in 22 out of 25 (88.0%) anemic children. Beta-thalassemia and homozygous Hb E seem to be important, while this was less obvious for heterozygous α-thalassemia and heterozygous Hb E. Conclusion: The results suggest that thalassemia and hemoglobinopathies may be major contributing factors to the occurrence of anemia in this area among the children’s population.


Thalassemia Hemoglobinopathies Iron deficiency Anemia School children 



Serum ferritin


Confidence interval


Red blood cell




Mean corpuscular volume


Mean corpuscular hemoglobin


Mean corpuscular hemoglobin concentration


Red blood cell distribution width



The study was supported in part by grants from the Graduate School, Khon Kaen University, and Office of the Higher Education Commission, Ministry of Education, Thailand. We would like to thank the directors and teachers of four schools; Choomchon Ban Wang Perm, Nong Ta Kai Pittaya, Ban Mai Sok Som Kob, and Si Chomphu Kindergarten school, Khon Kaen province, Thailand. Thanks to Dr. Ian Thomas for correcting the English.

Conflict of interest



  1. 1.
    Andert CU, Sanchaisuriya P, Sanchaisuriya K, Schelp FP, Schweigert FJ (2006) Nutritional status of pregnant women in Northeast Thailand. Asia Pac J Clin Nutr 15:329–334PubMedGoogle Scholar
  2. 2.
    Assantachai P, Lekhakula S (2007) Epidemiological survey of vitamin deficiencies in older Thai adults: implications for national policy planning. Public Health Nutr 10:65–70CrossRefPubMedGoogle Scholar
  3. 3.
    Cook JD (1994) Iron deficiency anemia. Bailliere Clin Haematol 7:787–804CrossRefGoogle Scholar
  4. 4.
    Brooker S, Akhwale W, Pullan R, Estambale B, Clarke SE, Snow RW, Hotez PJ (2007) Epidemiology of plasmodium-helminth co-infection in Africa: populations at risk, potential impact on anemia, and prospects for combining control. Am J Trop Med Hyg 77(Suppl):88–98PubMedGoogle Scholar
  5. 5.
    Brooker S, Hotez PJ, Bundy DA (2008) Hookworm-related anaemia among pregnant women: a systematic review. PLoS Negl Trop Dis 2:e291CrossRefPubMedGoogle Scholar
  6. 6.
    Florentino RF, Guirriec RM (1984) Prevalence of nutritional anaemia in infancy and childhood with emphasis on developing countries. In: Stekel A (ed) Iron nutrition in infancy and childhood. Raven Press, New York, pp 61–74Google Scholar
  7. 7.
    Fucharoen S, Fucharoen G, Fukumaki Y (1990) Simple non-radioactive method for detecting hemoglobin Constant Spring gene. Lancet 335:1527CrossRefPubMedGoogle Scholar
  8. 8.
    Fucharoen S, Fucharoen G, Sanchaisuriya K, Pengjam Y (2002) Molecular analysis of a Thai β-thalassemia heterozygote with normal hemoglobin A2 level: implication for population screening. Ann Clin Biochem 39:44–49CrossRefPubMedGoogle Scholar
  9. 9.
    Fucharoen G, Sanchaisuriya K, Sae-ung N, Dangwibul S, Fucharoen S (2004) A simplified screening strategy for Thalassaemia and haemoglobin E in rural communities in south-east Asia. Bull World Health Organ 82:364–372PubMedGoogle Scholar
  10. 10.
    Fucharoen S, Winichagoon P (1992) Thalassaemia in Southeast Asia: problem and strategy for prevention and control. Southeast Asian J Trop Med Public Health 23:647–655PubMedGoogle Scholar
  11. 11.
    Jetsrisuparb A, Sanchaisuriya K, Fucharoen G, Fucharoen S, Wiangnon S, Komwilaisak P (2002) Triple heterozygosity of a hemoglobin variant: hemoglobin Pyrgos with other hemoglobinopathies. Int J Hematol 75:35–39CrossRefPubMedGoogle Scholar
  12. 12.
    Lutter CK (2008) Iron deficiency in young children in low-income countries and new approaches for its prevention. J Nutr 138:2523–2528CrossRefPubMedGoogle Scholar
  13. 13.
    Milman N (2008) Prepartum anaemia: prevention and treatment. Ann Hematol 87:949–959CrossRefPubMedGoogle Scholar
  14. 14.
    Nuntakarn L, Fucharoen S, Fucharoen G, Sanchaisuriya K, Jetsrisuparb A, Wiangnon S (2009) Molecular, hematological and clinical aspects of thalassemia major and thalassemia intermedia associated with Hb E-beta-thalassemia in Northeast Thailand. Blood Cells Mol Dis 42:32–35CrossRefPubMedGoogle Scholar
  15. 15.
    Papadea C, Cate JC 4th (1996) Identification and quantification of hemoglobins A, F, S, and C by automated chromatography. Clin Chem 42:57–63PubMedGoogle Scholar
  16. 16.
    Prayurahong B, Tungtrongchitr R, Chanjanakijskul S, Lertchavanakul A, Supawan V, Pongpaew P, Vudhivai N, Hempfling AA, Schelp FP, Migasena P (1993) Vitamin B12, folic acid and haematological status in elderly Thais. J Med Assoc Thai 76:71–78PubMedGoogle Scholar
  17. 17.
    Robson KJ, Weatherall DJ (2009) Malarial anemia and STAT6. Haematologica 94:157–159CrossRefPubMedGoogle Scholar
  18. 18.
    Sae-ung N, Fucharoen G, Sanchaisuriya K, Fucharoen S (2006) alpha-Thalassaemia and related disorders in northeast Thailand: a molecular and hematological characterization. Acta Haematol 117:78–82CrossRefPubMedGoogle Scholar
  19. 19.
    Sanchaisuriya K, Chunpanich S, Fucharoen S, Fucharoen G, Sanchaisuriya P, Changtrakun Y (2005) Association of Hb Q-Thailand with homozygous Hb E and heterozygous Hb Constant Spring in pregnancy. Eur J Haematol 74:221–227CrossRefPubMedGoogle Scholar
  20. 20.
    Sanchaisuriya K, Fucharoen G, Fucharoen S (2002) Hb Pakse′ [α2, codon 142 (TAA→TAT or Term→Tyr)] in Thai patients with EABart’s disease and Hb H disease. Hemoglobin 26:227–235CrossRefPubMedGoogle Scholar
  21. 21.
    Sanchaisuriya K, Fucharoen S, Fucharoen G, Ratanasiri T, Sanchaisuriya P, Changtrakul Y, Ukosanakarn U, Ussawaphark W, Schelp FP (2005) A reliable screening protocol for Thalassaemia and haemoglobinopathies in pregnancy: an alternative approach to electronic blood cell counting. Am J Clin Pathol 123:113–118CrossRefPubMedGoogle Scholar
  22. 22.
    Sanchaisuriya K, Fucharoen S, Ratanasiri T, Sanchaisuriya P, Fucharoen G, Dietz E, Schelp FP (2006) Thalassemia and hemoglobinopathies rather than iron deficiency are major causes of pregnancy-related anemia in northeast Thailand. Blood Cells Mol Dis 37:8–11CrossRefPubMedGoogle Scholar
  23. 23.
    Thurlow RA, Winichagoon P, Green T, Wasantwisut E, Pongcharoen T, Bailey KB, Gibson RS (2005) Only a small proportion of anaemia in northeast Thai schoolchildren is associated with iron deficiency. Am J Clin Nutr 82:380–387PubMedGoogle Scholar
  24. 24.
    Tolentino K, Friedman JF (2007) An update on anemia in less developed countries. Am J Trop Med Hyg 77:44–51PubMedGoogle Scholar
  25. 25.
    Tungtrongchitr R, Pongpaew P, Phonrat B, Chanjanakitskul S, Paksanont S, Migasena P, Schelp FP (1995) Vitamin B12, folic acid, ferritin and haematological variables among Thai construction site workers in urban Bangkok. J Med Assoc Thai 78:5–10PubMedGoogle Scholar
  26. 26.
    Tungtrongchitr R, Pongpaew P, Schelp FP, Phonrat B, Mahaweerawat U, Paksanont S, Sanchaisuriya P, Jotking P, Intarakhao C, Saowakhontha S (1997) Vitamin B12, folic acid, ferritin and haemoglobin status of rural women in child-bearing age in northeast Thailand. J Med Assoc Thai 80:785–790PubMedGoogle Scholar
  27. 27.
    Weatherall DJ, Clegg JB (2001) Inherited haemoglobin disorders: an increasing global health problem. Bull World Health Organ 79:704–712PubMedGoogle Scholar
  28. 28.
    Weatherall DJ, Clegg JB (2001) The thalassemia syndromes. Blackwell Science, OxfordCrossRefGoogle Scholar
  29. 29.
    World Health Organization (2002) The World Health Report 2002: reducing risks, promoting healthy life. World Health Organization, GenevaGoogle Scholar
  30. 30.
    World Health Organization (2008) Worldwide prevalence of anaemia 1993–2005: WHO database on anemia. World Health Organization, GenevaGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Nichathorn Panomai
    • 1
    • 2
  • Kanokwan Sanchaisuriya
    • 3
  • Supawadee Yamsri
    • 1
    • 3
  • Pattara Sanchaisuriya
    • 2
  • Goonnapa Fucharoen
    • 3
  • Supan Fucharoen
    • 3
  • Frank P. Schelp
    • 2
  1. 1.Graduate SchoolKhon Kaen UniversityKhon KaenThailand
  2. 2.Department of NutritionKhon Kaen UniversityKhon KaenThailand
  3. 3.Centre for Research and Development of Medical Diagnostic LaboratoriesKhon Kaen UniversityKhon KaenThailand

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