Evaluation of efficacy of BIORAD D10TM testing system in detection of beta thalassaemia carrier

Background: Hemoglobinopathies especially thalassaemia and its interaction with HbE and HbS are significant cause of morbidity and mortality in our country. With no feasible treatment, prevention of cases by carrier detection is the only option for successful reduction of the disease burden. VARIANT hemoglobin testing system BIORAD using principle of cation exchange chromatography has been in use and considered as gold standard for carrier detection. The purpose of this study is to compare the efficacy of a different, cheaper instrument; D10 by the same manufacturer BIORAD for carrier detection in beta thalassaemia.Methods: Patients diagnosed as beta thalassaemia carrier by VARIANT hemoglobin testing system (HbA2 value between 4.0-9.0) were retested using D10 instrument and checked for agreement.Results: There was good correlation between VARIANT and D-10 methods with Intraclass correlation coefficient 0.832 (95% Confidence Interval 0.756-0.884). Bland-Altman analysis showed mean bias of +0.3526 (95% CI -0.3958 to +1.101).Conclusions: Although further study is needed with larger sample size for assessment of sensitivity and specificity of D10 instrument, it is evident from this study that this instrument can be an effective and cheaper alternative of VARIANT hemoglobin testing system.

Secondary hypertension in adults

Secondary hypertension occurs in a significant proportion of adult patients (~10%). In young patients, renal causes (glomerulonephritis) and coarctation of the aorta should be considered. In older patients, primary aldosteronism, obstructive sleep apnoea and renal artery stenosis are more prevalent than previously thought. Primary aldosteronism can be screened by taking morning aldosterone and renin levels, and should be considered in patients with severe, resistant or hypokalaemia-associated hypertension. Symptoms of obstructive sleep apnoea should be sought. Worsening of renal function after starting an angiotensin-converting enzyme inhibitor suggests the possibility of renal artery stenosis. Recognition, diagnosis and treatment of secondary causes of hypertension lead to good clinical outcomes and the possible reversal of end-organ damage, in addition to blood pressure control. As most patients with hypertension are managed at the primary care level, it is important for primary care physicians to recognise these conditions and refer patients appropriately.