Hereditary anemias in Hawaii. 1987.
The differential diagnosis of microcytic anemias in Hawaii presents special problems because of the hereditary anemias prevalent in its large Asian subpopulations. Both the alpha- and beta-thalassemias are important because of morbidity and mortality. Heterozygous carriers for either type mimic iron deficiency, which may lead to inappropriate work-up or treatment. The thalassemias and hemoglobin (Hb) variants are all benign in heterozygotes, but if a couple are both heterozygous for the same or for incompatible variants, their children have 25% risk of inheriting a serious anemia. These can be prevented by detecting the heterozygotes, and by offering genetic counseling and fetal testing to couples at risk of having severely affected children. Early detection is also possible by the screening of newborns. Fetal diagnosis, or early detection and treatment, can greatly reduce the consequences of these anemias. Screening and prevention will cost far less than the cost of care for affected patients.