Background: Hemoglobinopathies are the most common inherited disorders in the Mediterranean region, including Iraq, with different frequencies and molecular features. They represent an important health problem in Iraq. Several studies have addressed the prevalence of hemoglobinopathy in Iraq, but no specific research has addressed its prevalence in Zakho city, Kurdistan Region, Iraq. Thus, this study was conducted to address this issue. Materials and methods: A prospective cross-sectional study was conducted in a premarital screening center at Zakho Emergency Teaching Hospital, involving 11,910 Kurdish persons attending premarital screening investigations. Blood samples were collected from all participants for complete blood counts and sickling tests. A cut-off value of hemoglobin (Hb) concentrations (<13.0 gm/dl in males, <12.0 gm/dl in females), mean cell volume (MCV) <80 fl and/or mean cell hemoglobin (MCH) <27 pg, and the results of the sickling test were used to categorize the participants into three groups: group I, normal (normal Hb, MCV, and MCH, and negative sickling test); group II, individuals with MCV < 80 fl and/or MCH < 27 pg, with or without anemia, and negative sickling test; group III, sickle positive (individuals with a positive sickling test, with or without anemia, regardless of MCV and/or MCH values). Groups II and III underwent further evaluations by morphology, reticulocyte count, hemoglobin-H preparation, iron studies, and cation exchange high-performance liquid chromatography (HPLC). βthalassemia trait was diagnosed by hypochromic microcytic red cell indices and increased hemoglobin A2 (HbA2) (>3.5%). The sickle cell trait was diagnosed by the presence of a band at the S region at HPLC with a positive sickling test. Iron deficiency anemia (IDA) was diagnosed by hypochromic microcytic anemia and reduced transferrin saturation (<15%) and/or ferritin (<15 mg/L). Descriptive statistical analyses were conducted to define significant differences between the study's findings. Results: A total of 963 (8.09%) of the studied participants were in group II. Further investigations on these 963 cases confirmed a diagnosis of IDA in 610 (5.12%). β-thalassemia trait was detected in 308 cases, with an overall prevalence of 2.59%. δβ-thalassemia trait was detected in nine (0.076%) of the studied participants. A professional diagnosis of α-thalassemia was given to 36 (0.30%) of those with hypochromic microcytic red cell indices, normal iron studies, and HPLC results. A positive sickling test was seen in 48 participants and confirmed by HPLC as a sickle cell trait with a prevalence of 0.4%. The consanguinity rate among couples was 28.8%. Neither case of HbC or HbD trait, nor combined hemoglobinopathy, was detected in the current study. Furthermore, no differences were found between the prevalence of both β thalassemia and sickle cell trait with either sex and/or religion, with a p-value of 0.07, 0.07, 0.532, and 0.78, respectively. Conclusion: The prevalence of hemoglobinopathy in Zakho city is lower than in other regions of Iraq but still constitutes a significant burden on health services and financial resources. Careful interpretations of red cell indices, together with intensified premarital screening and counseling programs, coupled with an urgent need to increase awareness about the effects of consanguinity marriages on the prevalence of autosomal recessive disorders, can further reduce the incidence of hemoglobinopathies.

During the study period between May 2017 and May 2019, 255 patients were recruited. Recruiting patients were undergoing regular hemodialysis for renal failure in seven dialysis centers in Medical City Hospital, Al-Karama Teaching Hospital, Al-Kadymia Teaching Hospital-Baghdad, Al-Basra Teaching Hospital, Duhok dialysis center and Zakho dialysis center. A 5cc syringe and needle were used to obtain five ml of blood from subjects. Then, the samples were centrifuged at 1500 rpm for 3 min to obtain serum

To determine the frequency, clinical and laboratory associations of pulmonary hypertension in Iraqi Kurds with sickle cell anemia, a total of ninety four such patients attending a major hemoglobinopathy center in Iraqi Kurdistan were enrolled. All patients were re-evaluated clinically and had their blood counts, HbF, serum ferritin, LDH, renal and liver function assessed. Transthoracic Doppler echocardiography with measurement of tricuspid valve regurgitant jet velocity (TRV) was performed. A TRV in excess of 2.8 m/s was considered for the purposes of this study as indicative of pulmonary hypertension (PH). The prevalence of TRV in excess of 2.8m/s was 10.6%. By univariate analysis: significantly higher reticulocyte count, more frequent blood transfusions and pain episodes were encountered in the PH group as compared to the non-PH group (p = 0.001, 0.045 and 0.02 respectively). Moreover, PH patients had significantly higher mean right atrial area, left atrial size, E wave/A wave ratio and ejection fraction by echocardiography (p = 0.027, 0.037, <0.001 and 0.008 respectively). Except for reticulocyte count none of the other parameters remained significant by multivariate analysis (p = 0.024). In conclusion the current study revealed that pulmonary hypertension is rather frequent among Iraqi Kurds with sickle cell anemia, and identified reticulocyte count as an independently associated parameter with PH in this population. Future prospective studies including right heart catheterization and appropriate medical intervention are warranted.

Background: Glucose-6-Phosphate dehydrogenase (G6PD) is a key enzyme of the pentose monophosphate pathway, and its deficiency is the most common inherited enzymopathy worldwide. G6PD deficiency is common among Iraqis, including those of the Kurdish ethnic group, however no study of significance has ever addressed the molecular basis of this disorder in this population. The aim of this study is to determine the prevalence of this enzymopathy and its molecular basis among Iraqi Kurds. Methods: A total of 580 healthy male Kurdish Iraqis randomly selected from a main regional premarital screening center in Northern Iraq were screened for G6PD deficiency using methemoglobin reduction test. The results were confirmed by quantitative enzyme assay for the cases that showed G6PD deficiency. DNA analysis was performed on 115 G6PD deficient subjects, 50 from the premarital screening group and 65 unrelated Kurdish male patients with documented acute hemolytic episodes due to G6PD deficiency. Analysis was performed using polymerase chain reaction/restriction fragment length polymorphism for five deficient molecular variants, namely G6PD Mediterranean (563 C→T), G6PD Chatham (1003 G→A), G6PD A- (202 G→A), G6PD Aures (143 T→C) and G6PD Cosenza (1376 G→C), as well as the silent 1311 (C→T) mutation. Results: Among 580 random Iraqi male Kurds, 63 (10.9%) had documented G6PD deficiency. Molecular studies performed on a total of 115 G6PD deficient males revealed that 101 (87.8%) had the G6PD Mediterranean variant and 10 (8.7%) had the G6PD Chatham variant. No cases of G6PD A-, G6PD Aures or G6PD Cosenza were identified, leaving 4 cases (3.5%) uncharacterized. Further molecular screening revealed that the silent mutation 1311 was present in 93/95 of the Mediterranean and 1/10 of the Chatham cases. Conclusions: The current study revealed a high prevalence of G6PD deficiency among Iraqi Kurdish population of Northern Iraq with most cases being due to the G6PD Mediterranean and Chatham variants. These results are similar to those reported from neighboring Iran and Turkey and to lesser extent other Mediterranean countries.