book-of-sickle-cell-anemia-2

Chapter I

Introduction
Sickle cell disease is a genetic disease that causes a type of chronic anemia. A disease that produces a defect in hemoglobin located in the red blood cells. This hemorrhage is responsible for carrying oxygen to all parts of the body, if the lack of oxygen changes hemoglobin and becomes viscous. The red blood cells in the thyme begin to take the shape of the sickle instead of the normal spherical shape, and therefore have difficulty in passing through the vessels and fine hairs, so it is difficult to reach the blood for some parts of the body. Sporadic pains occur in the body and result in the breakage of red blood cells. And hemoglobin decrease.
Symptoms of this disease appear mostly in childhood. It lasts a lifetime. Severe cases may lead to death. This disease is characterized by the occurrence of seizures followed by a return to normal.
Sickle cell disease may affect every member of the body.
And lead to a variety of different symptoms. These symptoms vary in quality, severity, frequency and effect from one person to another and from one region to another. While some patients do not complain about any exhibitor and may reach the age of fifty and do not know they are infected with the disease.
In other regions, such as Africa, 50 percent of the infected population is under 2 years of age. This disease has no permanent cure, which is now reversible and healing, but it is possible to treat and alleviate the symptoms. It can also be prevented by a good choice of life partner.
Early diagnosis is very important and it is useful to know if the child is ill. Or sick, or healthy. Understanding the disease and its symptoms and the problems that result from it. Another important aspect is the medical, health and psychological interest of the patient, which enables him to lead a normal life and ease his pain.

Deployment:
According to statistics from the World Health Organization in 1985, it generates every year approximately 250,000 children in the world sick disease of blood diseases that are caused by an imbalance in the gene component of a series of beta hemoglobin, Beta Globin. Gene 75% of the number of people living with sickle cell anemia which it generates Every year, 189,500 children are infected in the world and this number is likely to increase significantly as a result of increased growth rates and increased care of patients, increasing their resistance and prolonging their age. Population migration has greatly affected the spread of the disease to various parts of the world such as northern Europe, the Americas and others.
A 1985 study in Bahrain examined the prevalence of the disease on more than a thousand thousands of moles. And found that 2.1% of them infected with the disease and 11% of them are infected with the disease.
But it is believed that the proportion of carriers in Bahrain is much higher and the reason is that the study was conducted on babies. In the immediate postpartum period, beta is not complete, but the gene (P), ie, hemoglobin, is still functioning. So there is a possibility that children with the disease as well as patients will not be detected at this stage.
In another study, students were examined in second grade secondary school in all schools in Bahrain. This study included approximately 6,000 students. This study showed that 2 and 1% of them had mengalemic anemia. And the proportion of those who carry the disease is 13%.
In Saudi Arabia, the disease is also widespread, particularly in the Eastern Province, Al-Hasa and Qatif, as well as in the Western Region.
In a similar study carried out in the Eastern Region on births, it was found that 24% of the patients were infected. 24%
As we have said, this disease is widespread in tropical Africa. In Nigeria, 25% of the population has the disease.
As well as in southern Italy, northern Greece and southern Turkey, where the proportion of 1040% of carriers of the disease. The prevalence of the disease was found to be proportional to the degree of localization of malaria in that region.

Source of disease:
We also said that sickle cell anemia is widespread in many countries of the world, but if we look for the source we find that there are two theories.
1 The first theory:
Says that the disease has one source, and that as a result of population migration, this gene has moved to all regions of the world. The majority says this source is Africa. With the largest number of infected people in the world, including spread to India, the Arab countries, America, Europe and the Middle East. The minority says that the source from the Arabian Peninsula and from there moved to Africa and the world.
2 The second theory:
Says that gene sources are multiple. (This theory is based on accurate studies of genetic material ”genes” using microbiological enzymes).
This theory says there are at least two sources of this gene. One is the genetic factor gene. Spread across West Africa, the Americas, the Middle East and western Saudi Arabia.
The second gene is prevalent in India, East Africa and the Eastern Province of Saudi Arabia. It is likely to be the gene prevalent in Bahrain.
In other words, there are two sources of the genetic factor, the patient is a source of Africa, and it is spread in the western regions of Saudi Arabia and is an Asian source and spread in Lahband in the eastern regions of Saudi Arabia.

Hemoglobin
Hemoglobin or hemoglobin is a partial circular shape This molecule consists of four chains of amino acids. Each of these amino chains wraps around an iron molecule. There are two types of amino acids in the hemoglobin of a person older than 6 months.

1 amino chain (alpha) the Alpha Globin the Chain and contains 141 amino acid.
2 amino series (beta) Beta Globin the Chain and contains 146 amino acid.

This hemoglobin is made according to orders issued by genes (genetic factors), these genes are found on chromosomes (Chromosomes) that resides inside the cell nucleus.

That is to say, for the hemoglobin of the average person after the age of the sixth month there are two types of genes:

Gene is the Beta Globin Chain Beta and is found on chromosome #11.
Jane is the Alpha Globin Chain and is on chromosome 16.

Since there are two chromosomes, one is from the father and one is from the mother. That is, it initiates two genes that determine the beta-amino acid chain on each chromosome 11.

If these genes are normal, their yield is normal hemoglobin. If the gene is abnormally abnormal, the yield is abnormal.

In the case of sickle cell anemia, the gene of the beta chain was found to be abnormal. As we have said, the beta globin chain (B) contains 146 amino acids. In the case of sickle cell disease, the amino acid (glutamac acid)
And (Glutamic acid) to the amino acid (Valine) (Valine).
At the level of d. N. a. DNA Any genetic material or gene is very small. So that the gene consists of a number of bases (Nacleotide Bases) change here is in the base of one of the GAG to GTG any pay from the base A to the base t T this change in one rule that makes partial hemoglobin ready to Tmangel Polymerization when less oxygen pressure.
We find that this simple difference in Mutation Point at the level of the gene (DNA) has changed the life of the whole human. And about a person who is a healthy person to a person suffering from pain throughout
Old. Here is the great divine power that created and mortified this complex and meticulous man.

Relationship with malaria:
The first observation of the disease was from Rhodesia in 1946.
Microscopy observed that the malaria parasite does not grow well and does not multiply normally in the blood of people with the disease. It was also observed that the mortality rate among people with malaria is lower among sickle cell anemia patients in the common people and came out with several theories, including:

1. People with the disease are less likely to develop malaria.
   2 – the rate of infection is one, but the complications are more in the ordinary people than in people with the disease.

2. People with the disease and who have the immunity to this disease more than ordinary people.

3. The presence of hemoglobin (o) provides protection against malaria at all ages, especially among children.

4. The malaria parasite prefers to feed on the normal hemoglobin » A « and preferably hemoglobin patient (s).
   6 – The shape of sickle red blood cells does not help to grow better parasitic parasitic, especially in children.

History of Malaria in Bahrain:
Malaria is known to have been prevalent in Bahrain. first
This report was issued by (Major Afridi) Major Afridi came in 1937 from the Institute Malaria Institute in Malaria, and investigated malaria prevalence in Bahrain.

It has been found to be the most widespread parasite, M. Stephani, and that the degree of malaria prevalence is:

He also wrote in a report that 70% of the villagers had been infected with malaria for a period of
Their lives where the spleen are inflated. The infection rate in Manama is 15%
Muharraq 1/2 5%. He also examined different samples of canals and orchards throughout Bahrain.

In 1938, the malaria control program began with the spraying of oily pesticides Swamps.
In 1940 (the year of the edition) there was a significant increase in malaria prevalence and has
The percentage of injury to the British army forces stationed in Bahrain in 1942 about 14%.
With a focus on efforts to combat malaria, the prevalence rate in 1946 dropped to 5 percent.
In 1946, he used the » d. Dr.. T . DDT « for the first time in Bahrain to exterminate Larvae and spraying at home has reduced the incidence of malaria significantly.

The malaria epidemic returned in 1959 again. The rate of injury was 5% among the population of Bahrain and it is said that the reason for the failure of d. Dr . T .
Between 1965 and 1969, there was a significant decline, with only 25 cases registered among Bahrainis. Among foreigners, 500 were registered from the affected areas, such as India and Pakistan.

In 1971 it became necessary to declare and report any case of malaria after being confirmed by a blood test. Since 1979, Bahrain has been free of malaria after this continuous fight. Since then, only the cases received have been recorded.

In 1980, it was necessary to conduct a blood test for approximately 80 people with each case detected by neighbors. As well as the continued use of strong and powerful pesticides and the screening and treatment of arrivals from infected areas. Control and inspect their areas of assembly.

Screening for sickle cell anemia:

1. The Sickle Cell Test
   And depends on the vision of the change in the form of red blood cells when exposed to hypoxia.

2 Solubility Test
This test is based on the fact that hemoglobin (S) is less soluble than normal blood hemoglobin in fluids, and while normal hemoglobin dissolves, hemoglobin (X) remains stable.

3 Electrophoresis testing Electro phoresis
Where separated blood hemoglobin normal » A « for patient hemoglobin (o). This shows whether a person is sick or is sick.

4 DNA analysis
Especially during pregnancy (screening during pregnancy) and immediately after childbirth.

Symptoms and treatment of sickle cell anemia:
Sickle cell disease as we have said may affect every member of the body and lead to various and different symptoms. These symptoms vary in type, intensity, frequency and impact from one person to another and from one region to another.
While most patients in Africa are severely affected, the patient is sick before reaching the second year of life. We find that the same disease in other areas like our region is relatively light. Where the infected person may reach the age of 20 and has not complained of any exhibitor. Many girls do not know they are ill until the first pregnancy.
Often, the symptoms of the disease do not start on the child until after the third month g between the third month and the sixth where the hemoglobin of the child before that age contains a different quality (fetal hemoglobin) (Hb.F.) This does not affect the disease. After the sixth month usually disappears fetal hemoglobin or almost and replaces normal hemoglobin (Hb.A)
Which affects the disease.

Symptoms:

1 Pains: Painful Crisis
Pain seizures are the most common symptoms and are believed to be due to clogging of small and fine blood vessels in the adherent and adherent clusters of red blood cells. The patient complains here of different and different pains in the limbs and joints such as the wrist joint. elbow. Ankle. And the knee. In the back, abdomen and chest. It is pale and lack of appetite. Nubia is often accompanied by high temperature. The urine color is dark and increases urination.
The episodes of pain occur in some patients every week and some of them every month or every several years and between periods of seizures the person is completely normal. This pain may last from 5 to 10 minutes and may last for several days or weeks depending on its severity and may require the patient to be admitted to the hospital.

As for the causes of Nubia are many and sometimes occur Nubia without any obvious reason.

Factors that help to occur include:

1 The oxygen content in the body is lower than the normal rate due to stress, as the body’s need for oxygen increases.
Lack of fluids in the body. When sweating is increased in hot weather and in cases of sunburn, diarrhea or vomiting.

2 When the body is infected with high temperature due to some diseases or infections.
Pregnancy: Pregnant women who suffer from sickle cell anemia are prone to seizures because of the large changes that occur in their body during pregnancy.

3 Travel to high mountain areas where air pressure or air travel is low in helicopters.

4 During surgical operations if there is a decrease in the proportion of oxygen.

5 Exposure to cold or sudden change in atmospheric temperature.

6 Slow circulation of some parts of the body, such as when using the compressor ligament (Torniquet) during the operations.

Treatment of a bout of pain:
The goal of treatment here is to relieve pain along with the removal of the sphincter.

1 Giving pain medication
Such as Pandol
Bonstan Ponstan
Provin Brufen
This should be under the guidance of the treating physician. As well as avoid the use of narcotic drugs that lead to addiction. Avoid the use of aspirin if the patient has a yeast deficiency disease (G6pd) as large amounts of aspirin may cause breakage of blood cells in this disease.

2 Fluid and drought prevention:
You must give a large amount of fluids. If the patient is unable to drink or has vomit, it should be given intravenously under the supervision of a physician such as Physiological Saline
Or 5% Dextrose and increased acidity in the blood.

3 Heating the patient and clothing appropriate clothing and prevent exposure to cold.

4 That the patient relax in the bed.

5 Treat infections as quickly as possible and prevent them from working the blood farm to find out the bacteria causing the heat.

6 Blood transfusion is not given unless there is a strong cause for this, such as hemoglobin deficiency. Blood transfusion may cause increased blood viscosity and a second more serious seizure. The use of Packed Red Blood is recommended.

7 The liver and spleen should be monitored twice a day during the seizure at least.
In order to detect the rapid spleen (Spellen Sequestration), and quickly treat it as it could lead to death if neglected.

8 Repeated blood tests to determine the degree of anemia during the bout Most often the proportion of hemoglobin is low and there is an increase in the number of leukocytes (Leukocytosis)

Abdominal pain:
The Nubia comes in the form of abdominal pain. Especially around the navel and sometimes accompanied by pain in the limbs as well.
The causes are not known exactly what is due to inflammation of the intestine or affected by the nerves of pain or inflammation of one of the lymph nodes or a clot in a vein or affected the bones of the back.
If the pain in the upper right of the abdomen may be caused by pebble in the gallbladder. Or inflammation of the gallbladder or hepatitis and hypertrophy. If it is in the upper left, the cause is affected by the disease. In the upper middle part, the cause may be inflammation of the chest and lung membranes. In the lower abdomen, the cause is inflammation of the urinary tract or kidney. Sometimes back pain occurs due to spinal cord injury.
Sometimes the disease causes inflammation in the 12 as a result of muscle injury and lining of the 12. It causes vomiting and hemorrhage. This symptom occurs here at a younger age than the normal age of 12-year-old ulcer disease. It is also not accompanied by an increase in acidity. Sometimes inflammation of the small intestine or large intestine and ulceration.
Abdominal pain often affects children and is repeated from time to time and lasts for several days. Most abdominal pain episodes are mild but sometimes severe and accompanied by vomiting, constipation, diarrhea, high fever, leukocytosis and anemia.
It may be confused with the symptoms of appendicitis, but many patients have had abdominal surgery to look for the causes of the pain.

Treatment of abdominal pain:
Rest in bed and monitor and give intravenous fluids as directed by your doctor.
Most abdominal pain attacks end after 1012 hours.

Inflammation:
Patients with sickle cell anemia are easily susceptible to various infections. And resistance to these infections is weak and the reason for the presence of anemia factor in addition to the immune system in this child is less than the average child. The work of the spleen affected the disease and affected the function of white blood cells.
So the child is susceptible to inflammation. Especially with species of bacteria such as Salmonella Salmonella and Pneumonia These inflammation include meningitis. Inflammation of blood. Bone inflammation. Skin ulcers when wounds occur. Chest infections. And urinary tracts.
So we should try to protect him from exposure to infections and attention to him when a rise in temperature and speed consultation with the doctor. And treat these infections quickly and effectively so as not to cause complications. It is recommended that the child wear appropriate protective clothing. Socks and shoes to prevent man’s wounds and pollution. In some centers, Pneumo coccal Vaccine is recommended for children above the second. Penicillin use penicillin for children before the age of two.

Inflammation of the parties Dactylitis Hand foot Syndrane
Inflammation of the limbs and fingers is painful swelling in the fingers of the hand, toes, back and foot and this symptom occurs often in childhood. It may be the first symptom. It occurs after the sixth month of age confuse with rheumatoid arthritis.

Urinary tract infections:
This is a common symptom, especially for children. As well as pregnant women and is mostly caused by bacteria. Special E. coli bacteria.

Bleeding with Urine Haematuria
This is also a common symptom in patients as well as carriers of the disease. There is a slight bleeding with urine due to congestion of blood vessels in the kidney, ureter and bladder. This symptom is common in children and affects males more than females.

The cure:
1 Increased use of liquids.
Give alkalis to treat acidity of urine.
3 May need to use drugs to increase coagulation in case of severe bleeding.
Spleen:

1. Increased spleen activity:
   Where it increases the activity of the spleen occurs acute anemia. A decrease in the number of Leukopenia and a decrease in the number of thrombo-cytopenia, making the patient less resistant. And are more prone to inflammation.

2. Inflammation of the spleen: Hypersplenism
   Where the spleen increases in size and increases its activity to a degree that requires the work of a process to get rid of it, but the process of disposal of the spleen have surgical complications. Since the spleen is an important member of the immune system, the elimination of the patient presents the ease of infection. If the process is decided to give the vaccination
   Vaccine Pneaumococca prior to the operation to increase erectile patient. After the operation, antibiotics such as Penicillin are given every two months if needed.

Spleen extension: Splenic Sequestration
This occurs for some patients, especially children between the ages of 9 months and 5 years. Which leads to accumulate very large numbers of cells Almtmangelh and deformed red blood in the spleen and enlarged spleen sudden, rapid and spoke acute anemia in the fluid in the body and this affects the flow of blood in the veins occurs very low blood pressure and lead to shock (Shock), along with severe pain in Abdominal swelling is caused by a significantly increased size of the spleen and this may endanger life and must be detected and treated quickly.
The treatment is concentrated in the recovery of fluid and blood lost in the spleen by giving fluids quickly and concentrated red blood cells (Packed Red Blood Cells) and if treated quickly, healing is fast.
But if delayed treatment may lead to death. This patient may return several times and here must be a process to get rid of the spleen. This dangerous symptom is rare in Bahraini patients.

Bone pain:
The bones are also affected by the clogging of the blood vessels as well as by increasing the size of the bone to increase the activity of secretion of more red blood cells. So that they can be compensated for. This affects the strength and strength of bones. It gets an increase in the size of the core component of the blood Krlt Erythropiotic Expansin then gets where necrosis Necrosis and weaken the bones and easily broken and changed the bones of the skull and become skull tower as a result of swelling of the bone marrow. It also delays the vertebrae and becomes brittle and easy to break.
Head bone necrosis thigh Aseptic Necrosis of Head of Femur where weakens and gets rounded thigh fracture and gets it.

Leg ulceration and leg ulceration
This occurs around the ankle and the bones of the man where the arrival of blood to those areas, coupled with the ease of clogging blood vessels Vtnaghar after the less shocks and strength begins to ulcer and the incidence of the presentation varies according to age and standard of living. It decreases in children while it increases at the age of 1019 years and should pay attention to these ulcers from the beginning. To prevent trauma and injuries. Secondly by cleaning it with disinfectants, using antibiotics, rest in bed and treating other symptoms.

Painful erection Priapism
A condition that occurs to the male. Erectile dysfunction occurs without any sexual consultation and is painful and lasts for a long time. This causes the accumulation and accumulation of sickle red blood cells in the blood vessels of the reproductive organ, which clogs the veins and obstructs the normal return of blood. He may need surgery to speed up the return of blood. The incidence of this offer is very low in Bahrain.
Stop Allanesi for the formation of red blood cells Aplastic Anaemia
The production of red blood cells in the spinal cord may stop abruptly, completely, and for different periods (for several days). This leads to severe anemia and requires rapid blood transfusion and patient monitoring.

Hepatic Crisis: Heparic Crisis
The liver is sometimes affected by the disease. Red blood cells may break down and break down as they pass through the microcircules of the liver, causing them to break down. The passage of blood stops, the pellets break down, the bile excretes increase, and the patient’s face appears brushed. The patient may also complain of pain in the upper right of the abdomen. Repeated blood transfusion can cause hepatitis and its complications.
The liver is also affected by iron accumulation due to repeated blood transfusions.

Lung inflammation: Acute Chest Syndrome type
This disease is common, particularly in children where the sickling process occurs in the lung veins and prevent blood access and cause lung infarction (Infraction) and inflammation of the lung Pneamonia are treated with rest and give fluids and give blood if needed and prefer erythrocytes concentrated blood and give the necessary vaccinations Pneaumococcal Vaccine for children after the Second Age And Penicillen for the treatment of children under the age of two.

Nervous system :
It is important to make sure that there is no difference in mental abilities and intelligence between sick children and ordinary children, but in severe and rare cases may occur in the brain and the vagina leads to:

1. Half paralysis.

2. Bleeding in the brain.

3. Fainting and convulsions.

4. The consideration is affected.

5. Impaired hearing.

6. peripheral nerve injury.

7. the occurrence of stroke (Stroke) absence of consciousness (stroke).

Here the treatment should be quick and effective and give rapid blood transfusion to increase the proportion of sickle cell hemoglobin.

Different species and the relationship of disease to other diseases:

1. Pregnant to the genetic agent of the disease Sickle Cell Trait
   This situation caused by the fact that the person carries a genetic factor and the other one patient and the worker shall be properly (holder genetic factor patient » Q. A «).
   The disease is widespread, with 11% to 15% of Bahrain’s population.
   It is believed that the pregnant female patient is healthy and that this condition is not a disease in the sense of the concept, but this person may suffer some complications in exceptional cases, for example in the case of hypoxia. This occurs when traveling to high mountain areas where air pressure is low or when traveling by non-air-conditioned aircraft or as a result of stress factors. In this case, the pregnant woman may suffer from the following:

2. feeling tired.

3. Feeling pain in different parts of the body.

4. bleeding with urine. Haematurea

5. Lack of ability to focus urine Hypothesurea

6. Uterine infections Bacterurea

7. Splenic Sequestration

The risk of this situation is in the possibility of her inheritance to the children. If a pregnant woman marries the genetic factor, another person, like the one with the genetic factor, has a 25 per cent chance of having sickle cell disease.
This is why:

1. Examine the next couple to get married.

2. Provide necessary genetic counseling.

3. neonatal screening to identify the quality of blood early. So that symptoms can be avoided.

4. Pregnant to the genetic factor of the disease of the disease and the disease of sickle cell disease:
   The two diseases react negatively, showing symptoms of anemia and some of the symptoms of thalassemia. The patient complains of pain and seizures. But the degree of disease depends on the type of beta thalassemia carried by the person.

5. Pregnant to the genetic factor of the disease of schistosomiasis and sickle cell disease:
   The genetic factor of the disease is widespread in our society. Where approximately 20% of the population carry this factor. Many studies say this factor reacts positively to sickle cell anemia.
   The presence of this agent alleviates some symptoms, not all. May reduce the incidence of inflammation of the chest and osteoporosis, but the incidence of pain is not less than the incidence.
   Continue to form Hetero-cellular Persistant of Fetal

Haemoglobin
The formation of embryonic hemoglobin persists in some people, which usually stop forming between the third month of life, thus increasing hemoglobin (H) f and the presence of fetal hemoglobin decreases the proportion of hemoglobin (Hb S) this pigment Polymerization any phenomenon that reduces sickling and relieves the symptoms of the disease. It was found that a large proportion of patients in Bahrain carry Hbf fetal hemoglobin by a variable rate.

5. the presence of yeast deficiency disease besides sickle cell disease
   Glucose 6 phosphate Defeciency
   It may occur that the person is infected with both diseases, since both of these diseases have a different gene. The genetic factor of sickle cell anemia is found on the chromosome (11). The genetic factor of yeast deficiency disease is found on the chromosome.
   Many studies say that the two diseases interact positively with some that leads to some of the symptoms.

Environmental factors:
The appropriate environmental factors affect the mitigation of symptoms of the disease as:

1. Care for the sick child.

2. take into account the nutrition appropriate health nutrition.

3. Give him all the necessary vaccinations.

4. Pay attention to clean and remove from the sites of infection and inflammation and heating and rapid response to each change gets.

5. in addition to interest in education and follow-up study.

6. You should also pay attention to the speed of presentation to the doctor if it happened and the temperature rose or any serious viewer appeared and follow the doctor’s advice.

7. Give medicines and give tonics such as Folic acid, iron and zinc all according to the doctor’s instructions.
   All of this affects less pain, less inflammation and complications.

Pregnancy, childbirth and use of contraceptives:
Many patients do not know they have the disease until the first pregnancy, especially between 30 and 40 weeks of pregnancy. If the disease is severe, there may be some serious complications that lead to the death of the fetus or the death of the mother.
The death of mothers during pregnancy and postpartum was found to be very low due to medical care and medical supervision of childbirth, but it was found that sickle cell anemia accounted for 20-30% of maternal deaths in Bahrain. Complications during pregnancy and childbirth include:

1. Severe anemia:
   The pregnant woman is usually exposed to anemia due to the consumption of the fetus part of the mother’s diet. If the mother does not take her food and take the necessary supplements, anemia occurs especially in the third period of pregnancy between 30 and 35 weeks.
   However, with sickle cell anemia, the anemia in the pregnant woman is much larger and may have serious complications such as liver and spleen enlargement. This offer is rare in our region but many occur in other regions such as African countries. It is recommended to follow the pregnant patient accurately and give the tonic, vitamins and iron along with good nutrition may need to transfer blood.

2. Bone pain:
   Bone and limb pain may increase especially in the last trimester of pregnancy and after childbirth. The reason may be the change in the hormones besides the increased spleen.

3. Acute chest pain Acute chest pain
   Inflammation of the lung membranes Pleuretic pain
   Difficulty breathing Dyspnea
   Inflammation of the chest Pneumonia
   It is usually increased in pregnant women with sickle cell anemia.

4. Eclampsia and Pre-eclampsia
   And includes high blood pressure, swelling and albumin urine, where it was found to increase the proportion of pregnant women with sickle cell disease.

5. Urinary tract infections. Urinary Tract Infection
   As the proportion increases with any pregnancy, but it is a greater proportion with pregnant women sick with sickle cell disease, especially the incidence of hepatitis.

Fertility Fertility
Many studies say that the disease does not affect fertility and that pregnancy is normal.

Birth:
Most pregnancies for pregnant women are normal and easy, especially since babies are often less fat than normal due to lack of growth due to anemia in the mother. However, surgery or assistance during childbirth may be recommended if the doctor doubts any exhibitor that may affect the life of the mother or child.

Obstetrics: Perperium
Postpartum infections are more common among patients with MS than normal births.
Low Birth Weight: Low Birth Weight
Pregnant women often have less than normal weight (2500 pounds), with children growing less as a result of child poverty.

Death of children:
Some studies show that abortion rates and preterm and postpartum deaths are higher than those among normal mothers. Health care and follow-up by pregnant women for medical visits during pregnancy reduce this.

Contraindications:
The best way to prevent pregnancy in this case is to perform the sterilization process which is safe and secure. Especially if the parents have only the number of children. It is preferable to follow family planning methods and spacing between births to give both the mother of the patient and the child enough time to regress and restore health. This alleviates many of the complications of the disease. There are complications for the pill and the contraceptive pills. The dependence on the safety period and ejaculation abroad is not guaranteed.

Screening during pregnancy:
It is possible to discover whether the fetus will be healthy or pregnant or sick by testing during pregnancy:

1. Take a sample of the amyonic fluid that surrounds the child after the third to fourth month and carefully examine the genes to determine if the genes are healthy at the fetus.

2. Examine part of the placenta at week 8 (10) and perform gene examination. In African and European countries it is recommended to abort fetuses if they have the disease. Especially that the disease is severe and may eliminate the child in the first life. The situation is different. As the subject of abortion is sensitive and unacceptable to us in addition to that the disease is mildly debilitating and patients live almost normal life. There are among us patients who have continued their studies and work and have been families. So we do not recommend abortion in this case.

Surgery and anesthesia:
Patients with this disease are exposed to operations such as gastrointestinal processes. Bones. Urinary tract. Spleen. Operations in the eye. Ear, Nose and Throat Nerves.
These operations are often the result of complications of the disease or as a result of accidents and emergencies, women and childbirth and others. Those who suffer from the disease have such operations as any normal person unless the oxygen given to the patient during the operation is significantly reduced. This is not usually the case. Hundreds or even thousands of operations have been carried out for carriers without any complications.
In the case of disease, the preparation must be well before the operation and should be kept as far as possible when conducting operations during seizures. And the proportion of hemoglobin 10 grams or more and opinions differ for giving blood if the proportion of hemoglobin 7 9 and advised to give oxygen before the operation and during anesthesia and continue to give oxygen more than the average patient.

Anesthesia: Anaesthesia
Precise devices are now available to monitor patient, breathing and enough oxygen to prevent all complications.

Usage of compressor ligature: Torniqnet
Surgeons sometimes need surgery especially for the use of the compressor to squeeze the limb so that blood is less and blood is reduced during the operation. This is a risk for sickle cell anemia. Where it gets tinged in the blood stopped in the end organ and when the pressure increases these cells go to the parts of the body and cause the stroke. Caution should be used when using the compressor ligament.

Process Complications:
Chest pain. Inflammation of the wound and painful attacks and strokes. But the patient here gives all care and attention to prevent the occurrence of these complications.

Inheritance of sickle cell anemia:
We also said that the disease is hereditary. Hemoglobin is determined by two genes.
One from the mother and the other from the father and the proper genetic factor resulting in a normal hemoglobin called ” A ” and the genetic factor of the patient produces hemoglobin ” X ”.

If the person inherited the gene responsible for hemoglobin » A « Father shall » A + A « which it carries normal blood hemoglobin.

If the worker inherits the ” X ” from a parent, his blood will be ” A “, a carrier of the hereditary factor for sickle cell anemia.

If the worker inherits the ” S ” from the mother and the father, the blood type is ” X ” and this person is sick with sickle cell anemia.

The children will inherit one gene from the father and the other from the mother, as the parents inherit one gene specific to the hemoglobin from the father and the other from the mother. The gene will be inherited by the child. This only God knows. No one can say which genes the next son will inherit. Is it the infected gene or the healthy gene?

Here the wife carries hemoglobin (A) and the husband carries a normal hemoglobin gene (AA) in this family. All children will be normal and there is no risk of a child being infected or having a disease.

Second Family:
The wife carries the normal hemoglobin (A) and the husband carries the genetic factor (AS). This means that the wife carries two of the normal genes (A) and the husband carries a healthy gene and a healthy gene. If they have a child,

1. The first possibility is that the son inherits two of the healthy genes and is intact (AA)

2. The second possibility is that the healthy gene inherits from the mother and the infected gene from the father becomes himself a carrier of the disease (AS) but there is no possibility of injury to a child, as he can not get the gene from the mother because it is healthy. That is, each child in this family has a 50% chance of being pregnant and 50% likely to be healthy.

Third Family:
Here the wife is infected with the disease, which carries (SS) and the husband pregnant of the genetic factor, ie, carrying the (A) that the wife has two of the genes infected. The husband has a healthy gene and the other is infected. If they have a child, there are two possibilities.

1. The first possibility is that the child takes the infected gene from each of his or her parents so that he or she is infected with the disease, such as the mother.

2. or take the right gene from the father and the infected gene from the mother (since the mother in this case can only give the gene infected) and be pregnant with the genetic factor of the disease (AS).

In other words, for every child there is a 50% probability of being a hereditary parent and 50% having the disease but can not be 100% healthy.

Fourth Family:

In this case both spouses carry the genetic factor of the disease. That is, the mother and the father have the blood type (AS), meaning that both parents have a diseased gene and a healthy gene.

What will happen now:

1. The first possibility: that the son inherits the proper gene from each of the parents (AA) is a healthy person.

2. To inherit the gene of the patient from each of his parents becomes (C) any infected with the disease.

3. Inherit the infected gene from one parent and the healthy gene from another, and become the holder of the genetic agent of the disease (AS), i.e., there is a 25% chance that the child is infected, 25% to be healthy, and 50% to be pregnant with the genetic factor of the disease.

When 25% say that one out of every four children does not mean that if the parents have a child who is infected, they will be followed by three healthy children. Because this probability is true for each child. It depends on the coincidence, not its memory. All children may come healthy or all of them are sick or two of them are sick and two are healthy.

Fifth Family:

Here the father is sick, i.e., carrying two of the diseased genes and intact mother, i.e., carrying two healthy genes. Each child will take a hereditary patient from the father and a healthy hereditary parent.

So all children will be sick. But the disease does not appear to them. There is no possibility of having sick children or completely healthy children.

This marriage…

Marriage is the most appropriate for a sick person. All the children are healthy, so advice is for everyone to know the quality of their blood. The disease spreads in our country. Every person who is married should know the quality of his blood and the blood of his wife so as not to be surprised to bring children suffering from illness throughout their lives.

In families where people are sick, prenuptial screening is necessary. Especially if the marriage of relatives is decided.

The Cure:

There is no cure that cures the disease completely and eliminates it. But treatment includes symptom treatment and continuous care for these patients, which reduces the frequency of attacks and relieves their suffering and makes their lives more likely.

1. Proper nutrition:

The patient needs calories (Calories) more than the average person, also needs more proteins. As well as the need for iron and Folic acid, which means that the food must be balanced and contain all the food needs and includes the fruits and vegetables.

2. Prevention of infections:

You should speed in the treatment of the infections. Especially if accompanied by high temperature, fatigue, paleness and swelling of the joints. Here the patient should be presented to the doctor so that he can quickly diagnose the cause of the infection and give the necessary treatment. However, immunity in these patients is weak as we said earlier and simple inflammation may lead to multiple infections including septesaemai, seborrheic inflammation, bone inflammation and meningitis.

4. Fluid:
   Drink plenty of liquids, especially diarrhea and vomiting. Lack of fluids and drought can cause a seizure.

5. Provide oxygen:
   Keep away from all causes of hypoxia such as stress, presence in closed and crowded areas, travel in non-air-conditioned aircraft or travel to high mountain areas.

6. Health Education:
   Health education about the disease for patients and their parents is very important. Where he knows more about the type of disease, symptoms, methods of prevention and treatment. It is possible to treat simple seizures at home to accept the disease as satisfied with the justice of God and mercy.

7. Wear socks and shoes while walking, to prevent exposure to foot wounds and infections.

8. Continuing Study and Education:
   There are many periods of absence from school and this affects educational attainment. Parents must cooperate with the school to reduce the period of scientific loss. Education is very important because these patients are more in need of office work than the work that needs a great muscle effort.

9. Games:
   The child should be encouraged to play, but not to the degree of stress and must be allowed to stop playing when he feels tired and tired.

10. Do not use ice and cold water compresses when the temperature rises.

11. Do not immerse the head in the water when swimming until sufficient amount of oxygen to the body.

    remember:

    1 The genetic factor of sickle cell anemia is not sick but may transmit the disease to his children.

    If you are pregnant with the hereditary agent for any of the blood diseases, do not forget it. And keep the result of a blood test among your personal papers.

    3 There is nothing wrong with carrying a hereditary factor for a disease of blood. Many of us carry it with your family, with your wife. I advise your relatives to do a blood test.

    4 If your partner does not have the same genetic agent for the disease you are carrying, there is no risk to children, but they must be screened for them in a timely manner. Some will be as sick as you are.

    5 If you and your partner carry the same genetic factor of the disease, it is best to visit the Department of Genetic Diseases.

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    Sickle cell anemia
    Instructions to avoid pain

    Here are some guidelines to help you prevent or reduce the pain of sickle cell anemia:

    1 – Increase the intake of fluids, and the doctor tells you about the amount of fluids that must be consumed daily. It is known that pain episodes increase when the body’s fluid content decreases. Milk and natural fruit juices are considered beneficial fluids for the body.

    2 – Eat well, and let your food be well balanced to include the four food groups.

    3 – Keep your body warm; wear socks, shoes, and a coat when the weather is cold. Underwear should also be worn under the outer clothing to warm the legs. Remember that exposure to the cold may cause pain.

    4 – Do not wear tight or narrow clothes; they press on the blood vessels and disrupt blood flow, which helps the blood cells of the patient to acquire the shape of sickle.

    5 – Relax and sleep enough at night; you may need a short nap during the day. Do not strain yourself too much. Fatigue and stress can cause pain.

    6 – Clean all wounds. If you bite an animal or if you have been injured or scratched, wash the wound with soap and water while keeping it clean and dry. Consult a doctor if injured. Wounds and sores from biting or scratching can become inflamed if not treated with care and speed, and inflammation causes pain.

    7 – Take care of your teeth. Dental hygiene is very important. Use a soft brush to gently brush your teeth after each meal and ask dental technicians to show you the right way to use the brush. Consult your dental clinic regularly. Any tooth decay may cause inflammation and this may cause pain.

    8 – Importance of vaccination and regular medical care. It is known that infections and diseases may cause pain and some of these diseases can be prevented by vaccination.

    9 – March exercise in moderation. Exercise is important for overall health, but those with anemia should be cautious and must exercise moderately and without stress. If you have this disease, you may not participate in sports competitions, and you should ask your doctor about appropriate sports and exercise duration.

    10 – Avoid high-altitude or non-air-conditioned aircraft. Low oxygen levels and low blood oxygenation cause pain in patients.

    If you feel any symptoms, see your doctor at the health center as soon as possible.

    Chapter II
    Endogamy

    Cohabitation is common in our society and is prevalent in many areas, especially Islamic countries. What are its advantages and what problems may result from it? What is its negative impact? Does it have any positive impact?

    Relatives are those who share a common ancestor, whether this grandfather is near or far. The common ancestor may be on the father’s or mother’s side. The relationship of kinship is significant between:

    1. Sons and cousins.

    2. Sons and daughters of the uncle.

    3. Sons and daughters of the aunt.

    4. The sons and daughters of the aunt.

    As well as aunts and maidens and nephews and nieces. The distant relatives, who share a single ancestor far from Jiayin or three ancestors, have a distant degree of kinship and have little influence.

    The marriage of relatives does not always mean there is a risk for children from genetic diseases. Some people believe that the marriage of relatives should lead to children who are deformed or have inherited diseases, and that all genetic diseases were caused by the marriage of relatives. This is a common mistake. In some cases, the marriage of relatives may be useful if you have good family traits such as intelligence, beauty, and other desirable qualities, but it may have bad effects if there are genetic diseases transmitted by the family.

    If we talk about heredity we find that each of us takes many of the characteristics of his parents like hair color, skin color, form of the nose, type of hemoglobin, length, etc. In both cells of the body there are two genetic factors that determine this genetic status: one inherited from the father and the other from the mother. You yourself will transfer these factors to your children. Most of the factors inherited from your parents that you will inherit for your children are 100 percent healthy, but some are sick.

    We also know that the son shares with the father ½ of his genes, where the other half comes from the mother. Brother and sister share ¼ genes. First-degree cousins share 1/8 genes. Second cousins (parents’ cousins) share 1/32 of genes. Third-class cousins (grandparents’ cousins) share 1/128 genes. Thus, the probability of carrying the same gene as the patient as the relative pair decreases as the kinship diverges. We also believe that in any marriage, even if there is no relative, the probability of any pregnancy for the wife to have an abnormal child is 23%. That is, the probability of non-natural or sick children exists even in the case of non-kin marriages.

    The specialists in genetic diseases have studied consanguineous marriage. Their study suggests that there is a significant risk to children of genetic diseases only in certain cases. It was also found that only one type of genetic disease is affected by the marriage of relatives: genetic diseases.

    Other genetic diseases, such as:

    1. Common genetic diseases:
       In this type of disease, it is sufficient for one parent to be infected, even with a mild illness, to transmit the disease to the children by 50% even if he does not marry his relatives or married a perfectly healthy person. These diseases include dwarfism and some cases of mental retardation that prevail dominantly and do not affect the marriage of relatives significantly.

    2. Gender-related genetic diseases:
       The genetic factor here is on the X chromosome that determines sex. The female has two chromosomes X. The male has one X chromosome and one Y chromosome. The fathers transmit the genetic agent to the daughters, who become carriers of the disease. The boys cannot transmit it to them because the Y chromosome gives them maleness without any genetic factors. Examples of this type of disease include G6PD deficiency.

    3. Chromosomal diseases:
       Where there is a defect in chromosomes either in number, composition, or shape. Examples include Down syndrome (Mongolian child disease). These diseases are rare and their frequency is rare in the family. If a parent has chromosome defects, these diseases are not related to the marriage of relatives.

    4. Congenital malformations at birth:
       Many studies say there is no direct relationship between the marriage of relatives and most of these diseases since most are caused by environmental and hereditary factors. Only a few are repeated in the family and the marriage of relatives has an effect.

    5. Common diseases between genetics and the environment:
       Such as diseases that appear with age or as a result of exposure to certain conditions like diabetes and hypertension, so the marriage of relatives has no direct impact. These diseases can be inherited regardless of marriage to relatives.

    If we talk about recessive genetic diseases, these diseases need two genetically ill patients in the same person to become sick. If you have one hereditary agent sick and the other is healthy, you are a healthy person because the healthy worker compensates for the effect of the patient. That is, the patient is suppressed or disappears behind the healthy factor and this person is called the carrier of the genetic factor of the disease.

    A disease that a person can carry and not show symptoms. They are common in our society:

    1. Sickle cell anemia.

    2. Thalassemia.

    3. Some diseases of mental retardation.

    4. Some metabolic diseases.

    If we use sickle cell disease as an example and review the inheritance of this disease, it gives us a complete example of the inheritance of recessive genetic diseases. Here we wonder how marriage can cause hereditary diseases.

    Sickle cell disease is a genetic disease but there are several thousand genetic diseases, some of which are rare. Only some of these diseases are recessive genetic diseases. That is, they need two genetic agents to show in the child. Only this quality is affected by the marriage of relatives.

    Some of these symptoms have an examination that determines the genetic factor of the disease, but many do not have this examination. It is not possible to detect the carriers of the disease.

    Each of us, however healthy, must have many diseased genetic factors (from 5 to 8), hereditary genetic factors for certain diseases we do not know about and may not be aware of. All diseases are rare.

    Often, the patient’s genetic factor is different from the patient’s genetic factor. It is rare for two people to have the same genetic factor to cope with the same disease, and here happens to produce an infected child.

    If you and your wife are from one family, there is a possibility that you inherited the inherited genotype from the same grandfather if there is a hereditary inherited disease.

    ---

    Here we review some of the families resulting from the marriage of relatives:

    • First Family:
      There is no genetic disease in the family, so there is no danger of marriage between cousins.

    • Second Family:
      There is a genetic disease in the family but the couple do not carry the genetic factor patient, so there is no risk to the children.

    • Third Family:
      There is a hereditary disease in the family but only one of them carries the genetic factor patient and the other is healthy, so there is no risk to the children.

    • Fourth Family:
      There is a genetic disease in the family and both parties carry the genetic factor patient. Here, there is a risk for children to get the disease. That is, even if there is a hereditary disease in the family, it does not mean all couples should be pregnant with the hereditary factor. It was found that the probability of the first class having the same genetic factor is 1/8 to 1/12 or 5%.

    ---

    When should we beware of the marriage of relatives?

    If a person knows that a member of his or her partner’s family has children with a chronic illness that begins early in life and is frequent in the family, it means the disease is likely to be genetic.

    In this case, it is best to consult with a doctor, study the condition, the extent of recurrence, and necessary tests to be sure whether the disease is hereditary or not. The disease may not be genetic, and there is no possibility of transmission to children, so there is no risk in marriage to relatives.

    If there is a possibility of a genetic disease in the family, the doctor will explain the disease in detail and the risk of injury to children, whether there is a cure, ways to detect it during pregnancy, and the possibilities if you marry your relative.

    As said, even if the couple thinks they have the same genetic factor, the probability

    Chapter III

    Prenatal examination

    Prenuptial examination should not be considered a duty. But indeed the rights of every person to marry. Many societies apply it. Especially in communities where there are many genetic diseases, especially if there is an examination to detect the carriers of the genetic disease prevalent in that community.

    For example, in Cyprus, the disease is spread, and the disease is dangerous, as the child is unable to form a red blood color, so it needs constant blood transfusions every three weeks. The spleen and liver are enlarged and the child lives in constant torment.

    So they fought the disease by creating a national program to spread awareness and information about the disease, and through medical education and examination of the carriers and the victims of marriage. By examination during pregnancy and after the birth of approximately 60 to 70 children with thalassemia each year in Cyprus, no child is born at all.

    It was also found that when Jews spread Tay Sach disease, which is a metabolic disease. It is a serious disease that destroys the child (mostly) before reaching the age of one. It was found that many Jews carry the genetic factor of the disease. It was found that in Ashkenazic Jews it was 25:1, 25 out of every 25 people diagnosed with the disease. They studied the disease extensively and studied the genes that caused it and reached the examination of it during pregnancy and through health education and the examination of the carriers of the disease and feet to marriage and the examination during pregnancy were able to reduce the incidence of them by a large proportion.

    Here, we find that genetic blood diseases are widespread in our country and to know the size of the problem, we say that one in every 10 people is pregnant with sickle cell anemia and generates every year about 200 Bahraini children infected with the disease and will continue to suffer from him throughout his life. And the proportion of carriers of the disease more than 11% of the population and spread between us Thalassemia both (alpha and beta) as well as yeast deficiency disease. With 20% of the population suffering from this disease.

    All two agree to marry and have hope to settle and have a healthy offspring. Having one child is seriously affected by their lives and all family members suffer. The mother and the father are busy with the sick child and the other children are not getting enough care. The family is far from comfortable and happy. This child will continue to suffer for the rest of his life. The father and mother will take care of him during their lives, but for those who will leave a sick person who is weak and who will care after them.

    That sickle cell anemia and thalassemia are recessive genetic diseases that need to meet two of the diseased genes in the child to make this child sick. If the father and mother carry the diseased gene, there will be a danger to the children. If only one of the parties is pregnant or sick and the other is completely intact, there is no risk to the children.

    We do not mean only blood diseases, but there are diseases that may be inherited by the family such as mental retardation and genetic deafness. Genetic blindness. Other diseases. Some of these diseases can only be prevented when choosing a life partner.

    Therefore, we recommend that you protect your children and future generations from these diseases as much as possible through prenatal examination.

    What happens in prenuptial counseling?

    Often the parties attend the fiancé and fiancé and inquire about the existence of any genetic disease in the family such as blood diseases, mental retardation, bone diseases, deafness, endocrine sight, frequent abortions in the family, early and recurrent child deaths, the presence of twins, and other diseases such as blood pressure, diabetes and the frequency of these diseases. We also inquire about the degree of kinship. This information is used for family members for at least three generations and the family tree is drawn.

    When there is one of the genetic diseases in the family, it is necessary to do the necessary for that disease and the blood test is conducted in addition to tests to detect:

    1. Genetic diseases transmitted by the family.

    2. Common genetic blood diseases in society.

    3. Infections that can be treated and the protection of embryos from their effect.

    As for the diseases inherited by the family, the tests are specific to each case for blood tests in the community. These are general and include tests to find out whether a person is pregnant or sick with sickle cell anemia, thalassemia and yeast deficiency.

    Tests have been conducted to determine the extent of infection diseases such as measles, syphilis, toxoplasma and others.

    Impact of German measles:

    The injury of the mother with German measles is often a minor injury, for example, that you get colds, colds and blisters on the skin, face, neck, body and limbs and disappear after several days. This is similar to infection with other viruses but has a significant impact on the fetus during the first pregnancy.

    1. The child affects various types of eye diseases.

    2. May have mental retardation, small head size, heart disease, small weight, lack of growth and deafness, and the sooner the injury, the greater the deformities caused by it.

    3. Fibrin is transmitted by the placenta and may cause miscarriage or death of the fetus as the child may die in the first year of life.

    In 1964, this disease caused the deformity of nearly 20,000 children worldwide. In order to protect against it, women should be vaccinated before marriage and also during the pregnancy.

    Effect of Toxoplasma:

    Toxoplasma infection is a common disease that is spread by saliva or spray, by having cats at home or by some birds or by touching raw meat and transmitted to the fetuses by the placenta. And symptoms in adults are similar to the symptoms of influenza may swell lymph nodes and accompanied by a slight rise in temperature and affects women more than men, especially in the age of 25 to 35 years. If the fetus is infected at an early stage (during the first trimester of pregnancy) it may be affected by some diseases such as eye diseases, especially retina and convulsions. The brain may also be affected, the size of the skull increases, the spleen and liver grow and the baby becomes yellow. A skin rash or pneumonia may be detected and can be detected by a blood test for both the baby and the mother. And treatment by giving antibiotics such as pyramidine and sulfa.

    Effect of syphilis infection:

    Syphilis and chronic affect the fetus especially in the first months of pregnancy and it affects every member of the body and is transmitted through the placenta and may cause abortion or death of fetuses before or immediately after birth. Or the birth of a dead and deformed child.

    If the child is infected in the last period of pregnancy may be born with syphilis. Here it must be treated quickly.
    Gonorrhea:

    It also causes injury to the fetus, especially eye diseases and infections. If the results of inflammation are positive, the infection can be treated or given the necessary vaccination before marriage and before the start of pregnancy.

    It is important to know that it is not our duty to dissuade persons who are married from completing this marriage. But the goal is to protect their children and help them create a healthy family. We study each case individually and provide the necessary advice and often in 95% of the cases there is no objection as our task is to advise and know the person to ensure the injury of children. Then the person must decide and choose what he wants for himself and he must bear the result of his decision, whether negative or positive. There is no coercion of any kind.

    If he chose to marry, despite the risk of injury to children, we try to help him avoid the injury of children by advising the organization of the navel and its methods and examination during pregnancy and other procedures. In spite of all the tests and care that may reduce the common genetic diseases prevalent in us, but the proportion of approximately 23% of births may be born and have a deformation or disease. This percentage is normal in the whole world and beyond what we can use to avoid it.

    HIV testing:

    If the person so requests or the circumstances so warrant.

    Fertility and Reproductive Testing:

    Does not work where the majority of infertility diseases have a cure now. Also, in some cases the parties are completely Solomon but do not happen to have children.

    Why genetic blood diseases?

    With the development of effective treatment and prevention methods such as vaccination, the risk of epidemic infectious diseases has been reduced to human health. The problem of controlling fetal and hereditary diseases has emerged, including some blood diseases affecting a significant proportion of people. In the UAE society, the incidence of serious hereditary blood diseases, especially thalassemia, causes permanent suffering for the patient and a material and moral drain on his family is the frustration of myself and the high costs of treatment that everyone can not afford. Therefore, the importance of health education is important for the nature, seriousness and prevention of these diseases.

    What are the components of blood?

    Until we have a clear picture of the nature of these diseases, we first have to identify the components of blood:

    Plasma: A watery liquid in straw color with 90% water that dissolves 10% of vital substances such as mineral salts and organic matter such as proteins. The plasma function is to carry food into the tissues and provide a liquid medium for the red balls to be pumped through the blood vessels.

    White blood cells: White blood cells resemble the body guard against the attacks of bacteria that invade the tissues and cause diseases, so the number of white balls increases when the person gets the disease.

    Red blood cells: red balls derive their color from a pigment containing them called hemoglobin or hemoglobin. The number of red balls is higher than that of white, and its function is to transfer oxygen to all tissues of the body.

    Platelets: These platelets are smaller in size and number of red and white blood cells and their function is based on blood clotting events when we are injured.

    Prevention of serious hereditary blood diseases.

    After reviewing the nature of some serious genetic blood diseases and methods of treatment and impossibility of healing, it became clear to us the extent of the seriousness of these diseases and the magnitude of the psychological and material burden on the family. Psychologically, parents suffer from feelings such as rejecting the reality of their child, overprotecting him, or sometimes avoiding him and being careful not to build a close relationship with him for fear of feelings of grief and separation later, although the child may live and lead a relatively normal life if he has treatment Appropriate early.

    Therefore, in order to avoid all these burdens and the suffering of the patient, we emphasize the need to commit to prevention, especially that our religion has been singled out by many of the verses and honorable speeches that urge us to reserve and forbade giving up the soul with its consent and choice in the destruction. The issue of prevention in Islam has included protecting parents from deadly or dangerous diseases that may cause them death or disability to lead a miserable life that interferes with the parents’ feelings.