What do you know about premarital screening?

Marriage is a thing of joy that should be enjoyed by both partners, not a thing to endure. Family, friends, colleagues, neighbours are always happy to hear that one of their own is getting married.
  In the past few days its been so disheartening for me, patients coming to the ER(emergency room) with bone pains crying and begging you to relieve them of their pains. The analgesics work for few hours and they are back to the excruciating pains. As a doctor you can't command the pains to go away, you can only commence your treatment as soon as they present and hope that they recover as soon as possible, show empathy to the patient and the relatives. Is usually not something to experience personally, trust me on this. I don't wish my enemies to have such a pain.
  Premarital screening tests done in our environment includes the following:

• HIV test
• Genotype
• Hepatitis B and C viruses

The HIV and Hepatitis B & C are usually not so much of a problem because we have discordant couples(where one partner is positive and the other negative),with drugs the couple can live their normal lives and also protect their children from getting infected.  I will dwell more on the genotype for this very post.
The genotype is where we always have a problem, if the couple after knowing their genotypes still decides to marry i.e AS and AS or SS and AS or SS and SS  
What is sickle cell disease(SCD)?
SCD is an inherited disease of red blood cells which affects the haemoglobin. There are 3 types ;AA, AS, SS .A lot of us do not know about it but some of us know about it and  still go ahead to marry when the possibility of having a child with SCD is there.  This is where you hear things like;we love each other, he is so wealthy I want to secure my future and that of my children, he is so handsome, we have known each other for years we can't just separate like that. All these reasons are so vain compared to the agony this child will face if he or she has SCD.

Image from: http://cornellbiochem.wikispaces.com/Sickle+Cell+Anemia

The above diagram shows the outcome in each pregnancy for a couple with the trait(AS).
Nigeria has the highest burden of SCD in Africa. We can prevent it by knowing our genotypes now and make informed  decision when we are about to get married.

Both parents and the child/children suffer major social and economic consequences in the following ways:

• A lot of money is spent during their admissions, they could stay up to a week in the hospital. Money is also spent for their routine drugs which they take through out their life. 
• You will always be away from work to take care of the child during admissions. If you work in a private sector, when is time to lay off some staff you will be no 1 on their list because you are always away from work to take care of your child and not contributing to the growth of the organization. Source of income is lost when it happens. 
• Depression: Psychologically, you will be depressed seeing your child/children in pain and yet you can't help. You can't sleep, work, all energy is on the child for him or her to recover.
• There will be a strain on the marriage. That is the time couples begin to blame each other if they are not strong enough to go through all the stress.
• The child could get other diseases during blood transfusion if the blood is not well screened.
• In some cases these children tend to repeat classes because they miss exams due to their crises. Stress is a predisposing factor to their crises, they sometimes are on admission during their exams. They either defer the exams or they do not perform well due to poor preparation. This too can depress the child, seeing his or her contemporary ahead of him or her.
• The reality is that some day the disease will take him or her away from you. The wish of every parent is for their children to take care of them when they get old.

For already affected children always try to get their routine drugs, stay away from triggers that could lead to frequent  crises, let them have their vaccines. Recently, University College Hospital (UCH) Ibadan, made it known that  bone marrow transplant is a therapy that could bring cure to SCD . This will definitely see children affected with SCD smile once again.

Feel free to ask questions and also share your experiences.

Thanks for visiting .