INTRODUCTION: Haemoglobinopathy testing is performed for carrier screening and evaluation of microcytic anaemia. We evaluated the effectiveness of thalassaemia screening tests at our institution and suggest ways of improving the testing algorithm. MATERIALS AND METHODS: A total of 10,084 non-antenatal and 11,364 antenatal samples with alkaline gel electrophoresis (AGE), capillary electrophoresis (CE), haemoglobin H (HbH) inclusion test, mean corpuscular haemoglobin (MCH) and mean corpuscular volume (MCV) were retrospectively reviewed. A subgroup of 187 samples with genetic testing was correlated with HbH inclusions and MCH/ MCV. The effect of iron deficiency on percentage hemoglobin A2 (HbA2) was studied. RESULTS: HbH inclusion test showed low sensitivity of 21.43% for α-thalassaemia mutations but higher sensitivity of 78.95% for deletion. By receiver operating characteristic (ROC) analysis, MCH ≤28 pg or MCV ≤80 fl for non-antenatal samples and MCH ≤27 pg or MCV ≤81 fl for antenatal samples had >98% sensitivity for HbH inclusions. Above these thresholds, the probability that HbH inclusions would be absent was <99% (negative predictive value [NPV] >99%). MCH ≥28 pg had 100% sensitivity (95% CI 95.63%-100%) for α-thalassaemia mutations and 97.68% calculated NPV in the antenatal population. Detection of haemoglobin variants by CE correlated highly with AGE (99.89% sensitivity, 100% specificity). Severe iron deficiency reduced HbA2 in hemoglobin ( <0.001) and α-thalassaemia ( = 0.0035), but not in β-thalassaemia. CONCLUSION MCH/MCV thresholds have adequate sensitivity for α-thalassaemia in the antenatal population, and genotyping plays an important role as HbH inclusion test shows low sensitivity. CE without AGE, may be used as initial screening for haemoglobin variants. Our study provides contemporary data to guide thalassaemia screening algorithms in Singapore.
Blood Protein Electrophoresis ; Electrophoresis, Capillary ; Erythrocyte Inclusions ; pathology ; Erythrocyte Indices ; Female ; Genetic Testing ; Hemoglobin H ; analysis ; Humans ; Male ; Mass Screening ; Pregnancy ; Pregnancy Complications, Hematologic ; blood ; diagnosis ; Retrospective Studies ; Sensitivity and Specificity ; Singapore ; alpha-Thalassemia ; blood ; diagnosis

Background: The Dark Triad personalities have been well studied, however, it is not often linked with empathy and risk-taking intentions. The present study aims to address this gap by examining the association between the Dark Triad personality traits, empathy and risk-taking intentions in the five domains – ethical, financial, health/safety, social, and recreational. Methods: A sample of 160 young adults residing in Malaysia (Male=69, Female=99, Mage=22.01, SD=2.03) completed the Short Dark Triad Questionnaire, Empathy Scale, and Domain-Specific Risk-Taking Scale through an online survey. Results: Machiavellianism and Psychopathy were positively associated with the five domains of risk-taking, including social, ethical, financial, recreational and health/safety domains, and negatively associated with empathy. Narcissism, on the contrary, was positively correlated to all risk-taking domains except for recreational risk-taking, and showed no significant relationship to empathy. Empathy was a significant predictor in social risk-taking whereas Machiavellianism and Psychopathy were significant predictors in ethical risk-taking intentions. Conclusion This study expanded existing knowledge on the Dark Triad personalities by demonstrating a link between each Dart Triad trait, potential risk-taking behaviours and empathy.
Risk-taking