Thalassemia in Viet Nam by Prof.Nguyen Anh Tri MD Ph.D Director - National institute of Hematology and Blood Transfusion President – Viet Nam Thalassemia Association

1. THALASSEMIA IN VIET NAM
Prof.Nguyen
Prof Nguyen Anh Tri M D Ph D
Tri, M.D, Ph.D
Director - National institute of Hematology and Blood Transfusion
President – Viet Nam Thalassemia Association
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2. Geographic
- Land area: 331.698 km2
- Population: 85.847 million (2009)
Estimated:
E ti t d 87 million (
illi (now)
)
- Life expectancy: 72,8 years
-The birth rate (2010): 1,64%
- New born babies: 1.4 million/year
- Ethnicity: 54 ethnic groups
Kinh: 85%
- Religions: Buddhist: 85%
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3. Geographic
 GDP(2010): about 104.6 billion USD
 Per capital income about $ 1.200 in 2010
 The budget expenditures for the health sector:
In 2011: 43 200 billion accounting for 5 95% of
43,200 billion, accounting for 5.95% of
total national budget
approximately U.S. $ 25 per person

4. Health system
Public system: four main routes:
(1) central (3) County/District
(2) provincial/city (4) village (local level)
Three main fields: research, treatment and prevention
, p
in institutes or leading hospitals at central level.
Private li i
P i t clinic: some of specialties
f i lti
big cities .
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5. Epidemiology
- Thalassemia carrier:
- Alpha thalassemia: 1,7%-25%, ~ 2,1% for average.
- βthal and βthal/HbE: 0,7% - 20%, ~ 1,4% for average.
- HbE gene: 1,7% - 41 %, ~ 2,6% for average.
- High rate in minority and mountain
g y
- Estimated 5,3 million people carry the disease congenital hemolytic
~ 2,400new births with thal disease amongs 1.4 million new
born babies every year, include 430 βthal, 520 βthal/HbE, 1050
yy , β , β ,
HbH and 435 Hb Bart
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6. Management
Thalassemia has been concerned by state and society:
 The screening programme and counselling that
in six districts of Hoa Binh province (Dr Truc’s presentation)
 Viet Nam Thalassemia association (ViTA) was established
in February 2011.
 E t bli h
Establishment of th l
t f thalassemia t t
i treatment unit
t it
 Many studies have implemented since 1960s
 Thalassemia is in the list of diseases which are covered by
Health Insurance
Insurance.
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7. Vietnam Thalassemia Association
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8. Thalassemia Unit
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9. Diagnosis and treatment
Diagnosis
Formula peripheral blood cells: all hospitals
Hemoglobin electrophoresis: some of provincial, all central
hospitals
Define Thalassemia gene in some hospitals
Prenatal diagnosis fetal diagnosis: Children's Central Hospital,
diagnosis, Children s Hospital
Tu Du Hospital.
Treatment
Blood transfusion: in the district provincial and central hospitals
district,
Iron chelating: Central Hospitals
Stem Cell Transplantation
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10. Diagnosis and treatment
Blood and blood products
Two forms of blood donation: Voluntary unpaid(84.2%), paid (15.8%).
y p ( ), p ( )
Voluntary unpaid is 92% at NIHBT
Each unit of 250 ml is about US $ 23.
Health insurance pay 100%, 95% or 80% (depending on the types)
Vietnam is moving toward implementation of the popularization of health
insurance
Blood for Thal patients
Frequency of blood transfusions for major and intermedia: once a month
(many patients could not go to the hospital for blood transfusion
because of their own situation)
Hemoglobin concentrations achieved after transfusion: 100g/l.
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11. Diagnosis and treatment
Iron chelators
Desferrioxamine and Deferiprone: available since 1996
To be used only in large central hospitals
Desferrioxamine is commonly used for all hospitalized
patients, Desferiprone was issued to outpatients
The medicine is covered by health insurance
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12. ACTION PLAN
1. Building national Thalassemia programs
2. Establishing Thalassemia center in Hanoi, then deploy
branches in the provinces
3. Screening and preventing programs in Hoa Binh
province and the others
4. Providing training for health staffs at the provincial
hospitals
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13. ACTION PLAN
5. Improving the quality of diagnosis
 Develop diagnostic and treatment protocol uniformly across
the country
 Deploying do hemoglobin electrophoresis in all provincial
hospitals
 Thalassemia genetic testing in the central hospitals
 Doing prenatal diagnosis in more hospitals
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14. ACTION PLAN
6. Improving the quality of treatment
 Bl d t
Blood transfusion: t i t provide enough bl d f Th l
f i trying to id h blood for Thal
patients
 Perform phenotype blood transfusion for patients with red
cell antibody
ll tib d
 Iron chelating: put iron chelators into the list of essential
medicines at the provincial hospitals
 Stem cell transplantation for patients with major beta
thalassemia
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15. ACTION PLAN
7. Strengthening activities of ViTA
Publication
Training for active members
Education for patients/family members
Step
St up operations t raise f di
ti to i funding
Propagate to community,
Marriage consulting is first priority.
8. Desiring to be twinned with other Thalassemia centers and
Thalassemia associations in the world.
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16. Thanks for your attention! 16