A Different Look at Premarital Hemoglobinopathy Screening in Primary Care

Eda Çelik Güzel; Aliye Çelikkol; Haluk Mekik

doi:10.18521/ktd.983680

Research Article

A Different Look at Premarital Hemoglobinopathy Screening in Primary Care

Year 2021, Volume: 13 Issue: 3, 621 - 627, 18.10.2021

Eda Çelik Güzel , Aliye Çelikkol , Haluk Mekik

https://doi.org/10.18521/ktd.983680

Cited By: 1

Abstract

Objective: Despite the high prevalence of hemoglobinopathies (HBP), the most common single-gene disorders in Turkey, data in some regions are lacking.
We aimed to evaluate the effectiveness of the hemoglobinopathy premarital screening program (PMS) and to investigate the contribution of efficient use of complete blood count (CBC) parameters on cost-effectivity.
Method: Hemoglobinopathy diagnosed 49171 subjects in 4 years and CBC of subjects with hemoglobinopathy in a year were evaluated retrospectively.
Result: The total incidence rate of HBP was 3.41%, β-thalassemia trait (β-TT) was 1.98%, Hemoglobinopathy incidence in the PMS group was 2.43%, β-TT was 1.08%. Moreover, HbF, HbD, HbC, HbS, HbE and HbJ were detected with the incidences of 0.49%, 0.14%, 0.05%, 0.04%, 0.007% and 0.009%, respectively. RDW/MCH ratio compared to other indices was the most successful for both sexes in diagnostic efficiency of HBP (AUC: male:0.922 - female:0.961) and β-TT (AUC: male;0.928 - female:0.961).
Conclusion: PMS was found to be an effective application program in hemoglobinopathy screening. RDW/MCH ratio was the most useful and easy parameter in detecting HBP and β-TT in PMS and in terms of reducing unnecessary test requests and cost-effectiveness in public health screenings.

Keywords

Hemoglobinopathy, Premarital screening, β-thalassemia trait, RDW, MCH

References

1. Smiers FJ, Krishnamurti L, Lucarelli G. Hematopoietic Stem Cell Transplantation for Hemoglobinopathies: Current Practice and Emerging Trends. Pediatr Clin North Am [Internet]. 2010 Feb 1 [cited 2021 Feb 25];57(1):181–205. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0031395510000040
2. Karimzaei T, Masoudi Q, Shahrakipour M, et al. A. Knowledge, Attitude and Practice of Carrier Thalassemia Marriage Volunteer in Prevention of Major Thalassemia. Glob J Health Sci [Internet]. 2015 [cited 2021 Feb 25];7(5):364–70. Available from: /pmc/articles/PMC4803916/
3. Sağlık TC, Açsap B, Müdürlüğü G. Hemoglobinopati Kontrol Programı. Available from: https://hsgm.saglik.gov.tr/tr/cocukergen-tp-liste/hemoglobinopati-kontrol-program%C4%B1.html
4. Cao A, Kan YW. The prevention of thalassemia. Cold Spring Harb Perspect Med [Internet]. 2013 Feb [cited 2021 Feb 25];3(2). Available from: /pmc/articles/PMC3552345/
5. Balci YI, Ergin A, Polat A, et al. Thalassemia premarital screening program: Public view, what has been done, what needs to be done? UHOD - Uluslararasi Hematol Derg. 2014;24(4):247–52.
6. Zlotogora J. Population programs for the detection of couples at risk for severe monogenic genetic diseases [Internet]. Vol. 126, Human Genetics. Hum Genet; 2009 [cited 2021 Feb 25]. p. 247–53. Available from: https://pubmed.ncbi.nlm.nih.gov/19390864/
7. Canatan D. Thalassemias and hemoglobinopathies in Turkey [Internet]. Vol. 38, Hemoglobin. Informa Healthcare; 2014 [cited 2021 Feb 25]. p. 305–7. Available from: https://pubmed.ncbi.nlm.nih.gov/25030194/
8. England JM, Fraser PM. Dıfferentıatıon Of Iron Defıcıency From Thalassæmıa Traıt By Routıne Blood-Count. Lancet [Internet]. 1973 Mar 3 [cited 2021 Feb 25];301(7801):449–52. Available from: https://pubmed.ncbi.nlm.nih.gov/4120365/
9. Mentzer WC. Dıfferentıatıon Of Iron Defıcıency From Thalassæmıa Traıt. Vol. 301, The Lancet. 1973. p. 882.
10. Shine I, Lal S. A Strategy To Detect Β-Thalassæmıa Mınor. Lancet [Internet]. 1977 Mar 26 [cited 2021 Feb 25]; 309 (8013): 692–4. Available from: http://www.thelancet.com/article/S0140673677921286/fulltext
11. Urrechaga E, Hoffmann JJML. Critical appraisal of discriminant formulas for distinguishing thalassemia from iron deficiency in patients with microcytic anemia. Clin Chem Lab Med [Internet]. 2017 Oct 1 [cited 2021 Feb 25];55(10):1582–91. Available from: https://www.degruyter.com/document/doi/10.1515/cclm-2016-0856/html
12. Ricerca BM, Storti S, D’Onofrio G, et al. Differentiation of iron deficiency from thalassaemia trait: a new approach. Haematologica [Internet]. 1987 [cited 2021 Feb 25]; 72(5): 409–13. Available from: https://pubmed.ncbi.nlm.nih.gov/3121463/
13. Uludaǧ A, Uysal A, Uludaǧ A, et al. Prevalence and mutations of β-thalassemia trait and abnormal hemoglobins in premarital screening in Çanakkale province, Turkey. Balk J Med Genet [Internet]. 2016 Jul 1 [cited 2021 Feb 25];19(1):29–34. Available from: https://content.sciendo.com/view/journals/bjmg/19/1/article-p29.xml
14. Sarper N, Şenkal V, Güray F, et al. Premarital hemoglobinopathy screening in Kocaeli, Turkey: A crowded industrial center on the north coast of Marmara sea. Turkish J Hematol. 2009;26(2):62–6.
15. Canatan D, Kose MR, Ustundag M, et al. Hemoglobinopathy control program in Turkey. Community Genet [Internet]. 2006 Apr [cited 2021 Feb 25];9(2):124–6. Available from: https://pubmed.ncbi.nlm.nih.gov/16612063/
16. Hashemizadeh H, Noori R. Premarital Screening of Beta Thalassemia Minor in north-east of Iran. Iran J Pediatr Hematol Oncol [Internet]. 2013 [cited 2021 Feb 25];3(1):210–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24575266
17. Ulutaş KT, Şahpaz F, Sarıcı İŞ, et al. Evlilik öncesi hemoglobinopati taraması: Kadirli, Türkiye beta-talasemi açısından riskli bir bölge mi? Türk Biyokim Derg [Internet]. 2014 [cited 2021 Feb 25]; 39(3): 357–61. Available from: https://app.trdizin.gov.tr/makale/TWpNME1qWXlNZz09/evlilik-oncesi-hemoglobinopati-taramasi-kadirli-turkiye-beta-talasemi-acisindan-riskli-bir-bolge-mi-
18. Belhoul KM, Abdulrahman M, Alraei RF. Hemoglobinopathy carrier prevalence in the United Arab Emirates: First analysis of the dubai health authority premarital screening program results. Hemoglobin [Internet]. 2013 Aug 7 [cited 2021 Feb 25];37(4):359–68. Available from: http://www.tandfonline.com/doi/full/10.3109/03630269.2013.791627
19. Schoorl M, Schoorl M, Van Pelt J, et al. Application of innovative hemocytometric parameters and algorithms for improvement of microcytic anemia discrimination. Hematol Rep [Internet]. 2015 Jun 23 [cited 2021 Feb 25];7(2):52–5. Available from: https://www.pagepress.org/journals/index.php/hr/article/view/5843
20. Rahim F. Microcytic hypochromic anemia patients with thalassemia : GGGGenotyping approach. Indian J Med Sci [Internet]. 2009 Mar 1 [cited 2021 Feb 25];63(3):101–8. Available from: https://pubmed.ncbi.nlm.nih.gov/19359777/
21. Bhattacharyya KK, Chatterjee T, Mondal UB. A comprehensive screening program for β-thalassemia and other hemoglobinopathies in the Hooghly District of West Bengal, India, dealing with 21 137 cases. Hemoglobin. 2016 Nov 1;40(6):396–9.
22. Velasco-Rodríguez D, Blas C, Alonso-Domínguez JM, et al. Cut-off values of hematologic parameters to predict the number of alpha genes deleted in subjects with deletional alpha thalassemia. Int J Mol Sci [Internet]. 2017 Dec 13 [cited 2021 Feb 25];18(12). Available from: /pmc/articles/PMC5751308/
23. Guan W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med [Internet]. 2020 Apr 30 [cited 2021 Feb 28]; 382(18): 1708–20. Available from: http://www.nejm.org/doi/10.1056/NEJMoa2002032
24. Xie YP, Cao YP, Zhu XJ, et al. Values of Hematological Indicators in the Screening of α-Thalassemia in Fujian Area of China. Zhongguo shi yan xue ye xue za zhi [Internet]. 2019 Feb 1 [cited 2021 Feb 25];27(1):165–9. Available from: https://europepmc.org/article/med/30738464
25. Sudmann ÅA, Piehler A, Urdal P. Reticulocyte hemoglobin equivalent to detect thalassemia and thalassemic hemoglobin variants. Int J Lab Hematol [Internet]. 2012 [cited 2021 Feb 25];34(6):605–13. Available from: /pmc/articles/PMC3533779/
26. Winichagoon P, Kumbunlue R, Sirankapracha P, et al. Discrimination of various thalassemia syndromes and iron deficiency and utilization of reticulocyte measurements in monitoring response to iron therapy. Blood Cells, Mol Dis [Internet]. 2015 Apr 1 [cited 2021 Feb 25]; 54(4): 336–41. Available from: https://pubmed.ncbi.nlm.nih.gov/25633854/
27. Srisupundit K, Piyamongkol W, Tongsong T. Comparison of red blood cell hematology among normal, α-thalassemia-1 trait, and hemoglobin Bart’s fetuses at mid-pregnancy. Am J Hematol [Internet]. 2008 Dec [cited 2021 Feb 25];83(12):908–10. Available from: https://pubmed.ncbi.nlm.nih.gov/18932192/
28. Bhattacharyya R, Iyer P, Phua GC, et al. The Interplay Between Coagulation and Inflammation Pathways in COVID-19-Associated Respiratory Failure: A Narrative Review. Pulm Ther [Internet]. 2020 Aug 25 [cited 2020 Sep 5];6(2):215–31. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32844302
29. Chatterjee T, Chakravarty A, Chakravarty S. Population screening and prevention strategies for thalassemias and other hemoglobinopathies of Eastern India: Experience of 18,166 cases. Hemoglobin [Internet]. 2015 Nov 2 [cited 2021 Feb 25]; 39(6): 384–8. Available from: https://pubmed.ncbi.nlm.nih.gov/26428539/
30. Charoenkwan P, Taweephol R, Sirichotiyakul S, et al. Cord blood screening for Α-thalassemia and hemoglobin variants by isoelectric focusing in northern Thai neonates: Correlation with genotypes and hematologic parameters. Blood Cells, Mol Dis [Internet]. 2010 Jun [cited 2021 Feb 25];45(1):53–7. Available from: https://pubmed.ncbi.nlm.nih.gov/20299254/

Birinci Basamakta Evlilik Öncesi Hemoglobinopati Taramasına Farklı Bir Bakış

Year 2021, Volume: 13 Issue: 3, 621 - 627, 18.10.2021

Eda Çelik Güzel , Aliye Çelikkol , Haluk Mekik

https://doi.org/10.18521/ktd.983680

Cited By: 1

Abstract

Amaç: Türkiye'de en sık görülen tek gen hastalıkları olan hemoglobinopatilerin (HBP) yüksek prevalansına rağmen, bazı bölgelerde veri bulunmamaktadır. Hemoglobinopati evlilik öncesi tarama programının (PMS) etkinliğini değerlendirmeyi ve tam kan sayımı (CBC) parametrelerinin etkin kullanımının maliyet-etkililiğe katkısını araştırmayı amaçladık.
Yöntem: 4 yılda 49,171 HMP tanısı konan olgu ve bir yılda HMP’si olan olguların tam kan sayımları geriye dönük olarak değerlendirildi.
Sonuç: HBP'nin toplam insidans oranı %3.41, β-talasemi taşıyıcılığı (β-TT) %1.98 bulundu. PMS grubunda HMP insidansı %2.43, β-TT %1.08 idi. Ayrıca HbF, HbD, HbC, HbS, HbE ve HbJ sırasıyla %0.49, %0.14, %0.05, %0.04, %0.007 ve %0.009 oranında tespit edildi. ROC analizinde diğer indekslere kıyasla RDW/MCH oranı, HBP (erkek:0.922- kadın:0.961) ve β-TT (erkek;0.928- kadın:0.961) tanısal etkinliğinde her iki cinsiyet için de en başarılıydı.
Sonuç: PMS, HBP taramasında etkili bir uygulama programı olarak bulundu. RDW/MCH oranı; HBP ve β-TT'nin saptanmasında ve halk sağlığı taramalarında gereksiz test isteklerinin azaltılması ve maliyet etkinliği açısından en kullanışlı parametreydi.

Keywords

Evlilik öncesi tarama, Talasemi taşıyıcılığı, RDW, Hemoglobinopati

References

1. Smiers FJ, Krishnamurti L, Lucarelli G. Hematopoietic Stem Cell Transplantation for Hemoglobinopathies: Current Practice and Emerging Trends. Pediatr Clin North Am [Internet]. 2010 Feb 1 [cited 2021 Feb 25];57(1):181–205. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0031395510000040
2. Karimzaei T, Masoudi Q, Shahrakipour M, et al. A. Knowledge, Attitude and Practice of Carrier Thalassemia Marriage Volunteer in Prevention of Major Thalassemia. Glob J Health Sci [Internet]. 2015 [cited 2021 Feb 25];7(5):364–70. Available from: /pmc/articles/PMC4803916/
3. Sağlık TC, Açsap B, Müdürlüğü G. Hemoglobinopati Kontrol Programı. Available from: https://hsgm.saglik.gov.tr/tr/cocukergen-tp-liste/hemoglobinopati-kontrol-program%C4%B1.html
4. Cao A, Kan YW. The prevention of thalassemia. Cold Spring Harb Perspect Med [Internet]. 2013 Feb [cited 2021 Feb 25];3(2). Available from: /pmc/articles/PMC3552345/
5. Balci YI, Ergin A, Polat A, et al. Thalassemia premarital screening program: Public view, what has been done, what needs to be done? UHOD - Uluslararasi Hematol Derg. 2014;24(4):247–52.
6. Zlotogora J. Population programs for the detection of couples at risk for severe monogenic genetic diseases [Internet]. Vol. 126, Human Genetics. Hum Genet; 2009 [cited 2021 Feb 25]. p. 247–53. Available from: https://pubmed.ncbi.nlm.nih.gov/19390864/
7. Canatan D. Thalassemias and hemoglobinopathies in Turkey [Internet]. Vol. 38, Hemoglobin. Informa Healthcare; 2014 [cited 2021 Feb 25]. p. 305–7. Available from: https://pubmed.ncbi.nlm.nih.gov/25030194/
8. England JM, Fraser PM. Dıfferentıatıon Of Iron Defıcıency From Thalassæmıa Traıt By Routıne Blood-Count. Lancet [Internet]. 1973 Mar 3 [cited 2021 Feb 25];301(7801):449–52. Available from: https://pubmed.ncbi.nlm.nih.gov/4120365/
9. Mentzer WC. Dıfferentıatıon Of Iron Defıcıency From Thalassæmıa Traıt. Vol. 301, The Lancet. 1973. p. 882.
10. Shine I, Lal S. A Strategy To Detect Β-Thalassæmıa Mınor. Lancet [Internet]. 1977 Mar 26 [cited 2021 Feb 25]; 309 (8013): 692–4. Available from: http://www.thelancet.com/article/S0140673677921286/fulltext
11. Urrechaga E, Hoffmann JJML. Critical appraisal of discriminant formulas for distinguishing thalassemia from iron deficiency in patients with microcytic anemia. Clin Chem Lab Med [Internet]. 2017 Oct 1 [cited 2021 Feb 25];55(10):1582–91. Available from: https://www.degruyter.com/document/doi/10.1515/cclm-2016-0856/html
12. Ricerca BM, Storti S, D’Onofrio G, et al. Differentiation of iron deficiency from thalassaemia trait: a new approach. Haematologica [Internet]. 1987 [cited 2021 Feb 25]; 72(5): 409–13. Available from: https://pubmed.ncbi.nlm.nih.gov/3121463/
13. Uludaǧ A, Uysal A, Uludaǧ A, et al. Prevalence and mutations of β-thalassemia trait and abnormal hemoglobins in premarital screening in Çanakkale province, Turkey. Balk J Med Genet [Internet]. 2016 Jul 1 [cited 2021 Feb 25];19(1):29–34. Available from: https://content.sciendo.com/view/journals/bjmg/19/1/article-p29.xml
14. Sarper N, Şenkal V, Güray F, et al. Premarital hemoglobinopathy screening in Kocaeli, Turkey: A crowded industrial center on the north coast of Marmara sea. Turkish J Hematol. 2009;26(2):62–6.
15. Canatan D, Kose MR, Ustundag M, et al. Hemoglobinopathy control program in Turkey. Community Genet [Internet]. 2006 Apr [cited 2021 Feb 25];9(2):124–6. Available from: https://pubmed.ncbi.nlm.nih.gov/16612063/
16. Hashemizadeh H, Noori R. Premarital Screening of Beta Thalassemia Minor in north-east of Iran. Iran J Pediatr Hematol Oncol [Internet]. 2013 [cited 2021 Feb 25];3(1):210–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24575266
17. Ulutaş KT, Şahpaz F, Sarıcı İŞ, et al. Evlilik öncesi hemoglobinopati taraması: Kadirli, Türkiye beta-talasemi açısından riskli bir bölge mi? Türk Biyokim Derg [Internet]. 2014 [cited 2021 Feb 25]; 39(3): 357–61. Available from: https://app.trdizin.gov.tr/makale/TWpNME1qWXlNZz09/evlilik-oncesi-hemoglobinopati-taramasi-kadirli-turkiye-beta-talasemi-acisindan-riskli-bir-bolge-mi-
18. Belhoul KM, Abdulrahman M, Alraei RF. Hemoglobinopathy carrier prevalence in the United Arab Emirates: First analysis of the dubai health authority premarital screening program results. Hemoglobin [Internet]. 2013 Aug 7 [cited 2021 Feb 25];37(4):359–68. Available from: http://www.tandfonline.com/doi/full/10.3109/03630269.2013.791627
19. Schoorl M, Schoorl M, Van Pelt J, et al. Application of innovative hemocytometric parameters and algorithms for improvement of microcytic anemia discrimination. Hematol Rep [Internet]. 2015 Jun 23 [cited 2021 Feb 25];7(2):52–5. Available from: https://www.pagepress.org/journals/index.php/hr/article/view/5843
20. Rahim F. Microcytic hypochromic anemia patients with thalassemia : GGGGenotyping approach. Indian J Med Sci [Internet]. 2009 Mar 1 [cited 2021 Feb 25];63(3):101–8. Available from: https://pubmed.ncbi.nlm.nih.gov/19359777/
21. Bhattacharyya KK, Chatterjee T, Mondal UB. A comprehensive screening program for β-thalassemia and other hemoglobinopathies in the Hooghly District of West Bengal, India, dealing with 21 137 cases. Hemoglobin. 2016 Nov 1;40(6):396–9.
22. Velasco-Rodríguez D, Blas C, Alonso-Domínguez JM, et al. Cut-off values of hematologic parameters to predict the number of alpha genes deleted in subjects with deletional alpha thalassemia. Int J Mol Sci [Internet]. 2017 Dec 13 [cited 2021 Feb 25];18(12). Available from: /pmc/articles/PMC5751308/
23. Guan W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med [Internet]. 2020 Apr 30 [cited 2021 Feb 28]; 382(18): 1708–20. Available from: http://www.nejm.org/doi/10.1056/NEJMoa2002032
24. Xie YP, Cao YP, Zhu XJ, et al. Values of Hematological Indicators in the Screening of α-Thalassemia in Fujian Area of China. Zhongguo shi yan xue ye xue za zhi [Internet]. 2019 Feb 1 [cited 2021 Feb 25];27(1):165–9. Available from: https://europepmc.org/article/med/30738464
25. Sudmann ÅA, Piehler A, Urdal P. Reticulocyte hemoglobin equivalent to detect thalassemia and thalassemic hemoglobin variants. Int J Lab Hematol [Internet]. 2012 [cited 2021 Feb 25];34(6):605–13. Available from: /pmc/articles/PMC3533779/
26. Winichagoon P, Kumbunlue R, Sirankapracha P, et al. Discrimination of various thalassemia syndromes and iron deficiency and utilization of reticulocyte measurements in monitoring response to iron therapy. Blood Cells, Mol Dis [Internet]. 2015 Apr 1 [cited 2021 Feb 25]; 54(4): 336–41. Available from: https://pubmed.ncbi.nlm.nih.gov/25633854/
27. Srisupundit K, Piyamongkol W, Tongsong T. Comparison of red blood cell hematology among normal, α-thalassemia-1 trait, and hemoglobin Bart’s fetuses at mid-pregnancy. Am J Hematol [Internet]. 2008 Dec [cited 2021 Feb 25];83(12):908–10. Available from: https://pubmed.ncbi.nlm.nih.gov/18932192/
28. Bhattacharyya R, Iyer P, Phua GC, et al. The Interplay Between Coagulation and Inflammation Pathways in COVID-19-Associated Respiratory Failure: A Narrative Review. Pulm Ther [Internet]. 2020 Aug 25 [cited 2020 Sep 5];6(2):215–31. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32844302
29. Chatterjee T, Chakravarty A, Chakravarty S. Population screening and prevention strategies for thalassemias and other hemoglobinopathies of Eastern India: Experience of 18,166 cases. Hemoglobin [Internet]. 2015 Nov 2 [cited 2021 Feb 25]; 39(6): 384–8. Available from: https://pubmed.ncbi.nlm.nih.gov/26428539/
30. Charoenkwan P, Taweephol R, Sirichotiyakul S, et al. Cord blood screening for Α-thalassemia and hemoglobin variants by isoelectric focusing in northern Thai neonates: Correlation with genotypes and hematologic parameters. Blood Cells, Mol Dis [Internet]. 2010 Jun [cited 2021 Feb 25];45(1):53–7. Available from: https://pubmed.ncbi.nlm.nih.gov/20299254/

There are 30 citations in total.

Details

Primary Language	English
Subjects	Health Care Administration
Journal Section	Articles
Authors	Eda Çelik Güzel 0000-0003-3022-4542 Aliye Çelikkol 0000-0002-3799-4470 Haluk Mekik This is me 0000-0001-8962-4562
Publication Date	October 18, 2021
Acceptance Date	September 27, 2021
Published in Issue	Year 2021 Volume: 13 Issue: 3

Cite

APA	Çelik Güzel, E., Çelikkol, A., & Mekik, H. (2021). A Different Look at Premarital Hemoglobinopathy Screening in Primary Care. Konuralp Medical Journal, 13(3), 621-627. https://doi.org/10.18521/ktd.983680
AMA	Çelik Güzel E, Çelikkol A, Mekik H. A Different Look at Premarital Hemoglobinopathy Screening in Primary Care. Konuralp Medical Journal. October 2021;13(3):621-627. doi:10.18521/ktd.983680
Chicago	Çelik Güzel, Eda, Aliye Çelikkol, and Haluk Mekik. “A Different Look at Premarital Hemoglobinopathy Screening in Primary Care”. Konuralp Medical Journal 13, no. 3 (October 2021): 621-27. https://doi.org/10.18521/ktd.983680.
EndNote	Çelik Güzel E, Çelikkol A, Mekik H (October 1, 2021) A Different Look at Premarital Hemoglobinopathy Screening in Primary Care. Konuralp Medical Journal 13 3 621–627.
IEEE	E. Çelik Güzel, A. Çelikkol, and H. Mekik, “A Different Look at Premarital Hemoglobinopathy Screening in Primary Care”, Konuralp Medical Journal, vol. 13, no. 3, pp. 621–627, 2021, doi: 10.18521/ktd.983680.
ISNAD	Çelik Güzel, Eda et al. “A Different Look at Premarital Hemoglobinopathy Screening in Primary Care”. Konuralp Medical Journal 13/3 (October 2021), 621-627. https://doi.org/10.18521/ktd.983680.
JAMA	Çelik Güzel E, Çelikkol A, Mekik H. A Different Look at Premarital Hemoglobinopathy Screening in Primary Care. Konuralp Medical Journal. 2021;13:621–627.
MLA	Çelik Güzel, Eda et al. “A Different Look at Premarital Hemoglobinopathy Screening in Primary Care”. Konuralp Medical Journal, vol. 13, no. 3, 2021, pp. 621-7, doi:10.18521/ktd.983680.
Vancouver	Çelik Güzel E, Çelikkol A, Mekik H. A Different Look at Premarital Hemoglobinopathy Screening in Primary Care. Konuralp Medical Journal. 2021;13(3):621-7.

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Assessing the comparative efficacy of multiple whole-blood count-based testing strategies for thalassaemia diagnosis: A meta-analysis

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https://doi.org/10.4103/ajprhc.ajprhc_37_23

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