Thalassemia in Sri Lanka

The island nation of Sri Lanka with 22 million people (in 2020) has an estimated 2000 patients with severe thalassemia. The majority have beta-thalassemia (beta-thal) major (beta-TM), and Hb E (HBB: c.79G>A)/beta-thal accounts for most of the remainder. Carrier rate for alpha(+)-thalassemia (alpha(+)-thal) trait is 9.9% and beta-thal trait is 2.5%, with very similar rates in the three major ethnic groups (Sinhalese, Tamils and Moors). The distribution of thalassemia type reveals a remarkable variation, even in this small island, mirroring historical distribution of malaria. Even though healthcare is provided free by the state including blood transfusions and chelation, the overall survival of patients of beta-TM is still not on a par with that of the Mediterranean countries. A national thalassemia prevention program was set up in 2007, but overall success of the exercise based essentially on dissuasion of marriages is not very promising.