Authors: SUHAIB AHMED, MOHAMMED SALEEM, BERNADETTE MODELL AND MARY PETROU
Background We have investigated a strategy for identifying and counseling carriers of recessively inherited
disorders in developing countries where consanguineous marriage is common. In such communities,
gene variants are trapped within extended families, so that an affected child is a marker of a
group at high genetic risk.
Methods Fifteen large Pakistani families, 10 with a history of a hemoglobin disorder and 5 without any
such history (controls), were screened for b -thalassemia and abnormal hemoglobins. All carriers and married
couples consisting of two carriers received counseling, and eight families have been followed for two
Results In the control families, no carrier was found among 397 members tested. In the 10 families with
an index case, 183 of 591 persons tested (31 percent) were carriers; carriers had a 25 percent risk of being
in a marriage at risk for producing an affected child, and 17 of 214 married couples (8 percent) consisted
of two carriers. No couple at risk was identified among 350 randomly selected pregnant women and their
partners. All carriers reported that they have used the information provided in the testing and counseling
process: carriers married to carriers with two or more healthy children have avoided further pregnancy, and
most such couples with one or no healthy children have used prenatal diagnosis. Seven of eight new marriages
and engagements are known not to be at risk.
Conclusions Testing of extended families is a feasible way of deploying DNA-based genetic screening in communities in which consanguineous marriage is common.