Don’t deliver a patient; know your sickle cell status before marriage [Article]

I saw this on one of my pages on WhatsApp and I loved it so much though its severity was toned down.

It was titled ‘know your genotype before you say yes to that handsome guy or that beautiful lady who you wish to spend the rest of your life with……Genotype and its appropriate suitor:’

AA + AA = excellent

AA + AS = Good

AA + SS = Fair

AS + AS = BAD

AS + SS = Very bad

SS + SS = Extremely Bad (in fact, don’t try it)

I feel so concerned anytime I come across a positive sickling test under the microscope especially when it’s coming from a child, even though a positive Sickling test result does not confirm Sickling disease.

This is not only because of my background in medical science but also common observations, strange happenings, and the myths that are associated with sickle cell patients even in the modern urbanized and knowledge glut setting we currently find ourselves called a global village.

With my knowledge in sickle cell disease, I have always advised people to prevent at all cost giving birth to a child who will arrive on earth with a preventable inheritable disease. It rather happens that people are still unaware of the dangers associated with marrying a sickle cell positive lady/guy when your sickling test proves to be positive even without the genotype.

People are now getting married out of frustration and therefore accepting to get along with whatever comes their way.

In my view, getting married to a sickle cell positive person if one knows his/her status to be positive is in itself deadly.

Sickle cell disease is one of the genetic diseases I will always advise couples preparing to tie the knot to be wary about. It is highly traumatic, suicidal and can drain the entire family of wealth, health and spiritual growth.

In the traditional Ghanaian culture, an attempt to prevent the spread of the disease and its bag of symptoms and health implications, families with history of this disease popularly known as ‘Ahotutuo’ are prevented from getting married among themselves.

I remember when a guy from one of such families wanted to date my sister, my mum used all her effeminate wit to prevent such an ungodly union even though we didn’t have traits of the disease in my family. This shows the aversion shown by many a traditionalist to this disease.

In this era where access to information and research has reached its peak, we still come across young children who by no fault of theirs are born with the disease. I always ask myself: why will someone want to give birth to a child just for him/her to come to this earth and suffer all his/her life? They go through hectic moments and in some cases lose their lives.

A lecturer narrated a live story which surprised and petrified me at the same time.
A pharmacist and a nurse were about getting married and as head pastor and a medical scientist, he was chosen to be their counsellor. The two knew their sickling status. The man was AS likewise the woman.

After series of counselling to stop the marriage, the two insisted that they are committed to each other and are ready to welcome any thing that comes their way.

They could even prove their spiritual commitment to God, that God will not give them sickle cell patient knowing the probabilities. They got married and started producing. Their first child was SS, the second SS. The wife had to quit work in order to meet the needs of the two, regular hospital care and the like.

After three years, the man had to close down his pharmacy because it had run out of resources. They then gave birth to the third child who was also SS. Two month afterwards the second child died. The two then agreed to divorce to prevent another SS. What charismatic sense is in this? Was marriage meant to make things better or worse?
Just last week, I came across another instance that was far more serious and dangerous.

A lady had agreed to marry an SS man who had lived in the UK and had a fat bank account.

The lady was AS so they fall in the ‘very bad’ category. They had agreed that anytime the lady got pregnant, they’ll determine the status of the foetus through a process called amniocentesis and Chorionic villi sampling and terminate the pregnancy till they had one free from the SS ‘curse’.

They appeared to be comfortable with it. My basic question was; how can you risk your life with such recklessness not considering the attendant emotional and social risks associated with an abortive process.

These are few scenarios that keep my scientific mind going to and fro like the devil in the book of Job.

On the scale above, in my opinion, after ‘fair’ all, the others below must be prevented.

The child has done no wrong to come to this world to suffer. It is not enough to marry because of so-called love or money. I like the move by some churches and their leaders recommending and sometimes insisting on medical assessment as part of premarital counselling. There is the need to seek medical counselling in addition to social and spiritual counselling.

Knowing your status is a relatively simple and inexpensive process. Investigation for sickling status is in two folds: the sickling test and haemoglobin electrophoresis test.
The two can be done in most medical laboratories in our hospitals and some clinics. There are numerous private laboratories that do this test also. You would want to patronize the services of a standardized laboratory for accuracy and precision considerations.

What the laboratory need is just about 2 millilitres (2ml) of blood that will be obtained by a qualified person (Phlebotomist). There is a 98% assurance that blood will be obtained without any complication when taken by a qualified person.

Test result can be ready 5 hours after blood collection or up to sometimes few days depending on the workload of the laboratory and/or their internal policies. You can find out on the collection time before you do the test.

This test should not cost more than GHS 100 and can be as low as GHS 30 in some laboratories.

It is sometimes free when requested as part of prenatal screening for clients who are registered with the National Health Insurance Scheme (NHIS).

The sickling test will just tell if the person is sickling positive or negative. This is then followed up with the haemoglobin electrophoresis which gives the genotype either: AA, AS, SS, SC, and few others which are not very common.

Being sickle cell positive means you have an ‘S component’ as part of the haemoglobin molecule as in AS, SS, or SC. But it is only a person with ‘SS’ who will show symptoms to the disease. While the others will be carriers.

This genetic disease can be prevented if you make the right choices.
Let me state again, that the child has done no wrong to come and suffer on earth.

Trust Sickle cell disease to drain the family of wealth, health and spiritual growth.

By: Kyeremeh Evans (MLS)

[email protected], 0504665859/0240352524

The writer is a Biomedical Scientist and a Medical advocate. He is currently working with a reputable health facility in Ghana.

He is a symbol of laboratory science and an epitome of professionalism. He has a motivation to help harmonize health professions and systems to provide the needed output for patients care and satisfaction.

He advocates for good medical practice and patients’ right. What do you know of laboratory medicine/science and your Lab test? Get in touch…

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