Blood disorders are a public health issue

Public health should focus not only on reducing the burden of common diseases but also address the needs of people with blood disorders , experts say in a supplement to December's American Journal of Preventive Medicine.

Even relatively common blood disorders fly below the public health system's radar with no established mechanisms for surveillance, supplement editors Scott D. Grosse, PhD, of the US Centers for Disease Control and Prevention (CDC); Andra H. James, MD, of Duke University; and Michele A. Lloyd-Puryear, MD, PhD, of the US National Institutes of Health, write in an introductory essay with Hani K. Atrash, MD, MPH, also of the CDC.

The authors contend that although most of the blood disorders discussed in the supplement are considered rare in the US and Western Europe—defined as affecting about 1 in 1,500 people—they should be ranked as a public health concern. "A public health framework is needed to address public health services and functions for all rare disorders, including blood disorders, regardless of the incidence or prevalence of a given disorder," they say.

The most common blood disorder, venous thromboembolism (VTE), consists of deep vein thrombosis and pulmonary embolism. It involves blood clots that occur in veins, usually in the legs, which can break up and move to the lungs and kill. VTE affects at least 1 million people in the US and is a major cause of death in adults, but "little is definitively known about the magnitude of [its] public health burden."

Hereditary hemochromatosis is a genetic disorder present in about 1 million Americans but "the opportunity to detect iron overload at an early stage and intervene … to prevent the development of clinical disease … remains a challenge," they add. And while at least 3 million Americans have sickle cell trait or are carriers of the sickle cell gene mutation, "the extent to which the carrier status poses health threats is not well established."

Dozens of different diseases can involve the blood. Blood disorders can affect any of the three main components of blood -

Red blood cells, which carry oxygen to the body's tissues
White blood cells, which fight infections
Platelets, which help blood to clot
Blood disorders can also affect the liquid portion of blood, called plasma.

The supplement, comprised of 13 research papers and five workshop/meeting summaries, is authored by top medical educators and public health professionals. Its publication was supported by the CDC through a cooperative agreement with the Association for Prevention Teaching and Research.

Two papers focus on sickle cell trait screening policy in college athletes and military recruits, while seven address hemophilia and bleeding disorders, the most common of which are hemophilia A and B, and the hemoglobinopathies- sickle cell disease and thalassemia.