Sickle Cell Disease: Genotype Awareness Matters More Than Love

Sickle Cell Disease is a serious health condition that affects millions of people worldwide. In the fight against this genetic disorder, it’s crucial to understand that love alone is not enough.

Gone are the days when our parents fall in love and just get married without taking some necessary tests such as genotype and check for sexually transmitted diseases/infections and so on. This, of course, we would say was out of ignorance because they didn’t know better and always prefer falling back to traditional means. Some get lucky while some do not.

Well, luckily for us the world has evolved and the majority of us to the very least are enlightened or getting enlightened. In fact, some churches won’t wed a couple when things like this haven’t been done. Yes, it’s that serious and a church shouldn’t even be the one to force you into doing a test. Because at the end of the day, it’s still for your own good as well as the good of your unborn children.

So in general, Nigerians seem to be aware of the existence of genotypes. Though sadly, in rural populations, there appears to still be widespread ignorance about the consequences of not paying attention to genotype compatibility. Many people don’t know that for each pregnancy in which both parents are AS, there is a 25% chance of them giving birth to a child with the sickle cell genotype. The implication of this statistic is that each pregnancy is a mutually exclusive event and the chances of having a sickle cell baby do not reduce with successive pregnancies. Every pregnancy has a 1 in 4 chance of producing a baby with this disorder.

I know quite a number of relationships that have been shattered painfully along the line all because of genotype incompatibility. I sure know how it feels and it can be pretty devastating. People who have been there would probably advise that knowing the person genotype should be a piece of information shared on the first date. So you can navigate your way through and know where you will take your heart to very early (LOL). Yes you guys might not be in a serious relationship yet but you see potentials of it happening, you are not being too forward if you choose to know; trust me. We could say it reduces the hurt.

A smart man or woman knows how to love but an intelligent man or woman knows WHO to love.

Anyways, without further ado, I would just cut to the chase. Many of us might be hearing genotype and not know exactly what we are talking about. So for a start………….

what is a genotype?

A genotype is the genetic constitution of every individual. Your genetic constitution is the genes you inherit from both of your biological parents, you get part from your mother and part from your father, the part becomes a whole that makes you.

Each genotype codes for a specific feature and gives rise to observable outward or physical attributes, called phenotype which mostly depends on the genotype and the environment.

Examples of genotypes include AA, AS, AC, SS, SC, Sβ-Thalassemia etc Your genotype is made up of different HAEMOGLOBIN GENES you inherit from both of your parents. A person with genotype AS can either donate the A haemoglobin gene or the S haemoglobin gene to his/her child, SC can donate the S or the C  while a person with AA genotype can only donate haemoglobin A, a person with SS can only donate the S haemoglobin gene to his/her child etc.

Though the four main types of haemoglobin gene in humans are: AA, AS, AC and SS. Only haemoglobin AA is normal while AS and AC are carriers, containing the abnormal gene but do not have sickle cell disease. Sickle cell disease develops when an individual inherits a defective haemoglobin genotype from each parent.

When genotype is discussed in love and relationships, it is often about genetic disorders – diseases that can be passed from parents to their offspring, the chief of which is sickle cell disorder in our environment.

Carriers of the abnormal haemoglobin gene are advised to marry individuals with a normal haemoglobin genotype (AA) to prevent sickle cell disease, a multisystemic lifelong disease that limits life expectancy and productivity, in their children.

SICKLE CELL DISEASE

Sickle cell disease is a genetic blood disorder which is characterized by the inheritance of two abnormal haemoglobin genes (one from each parent) and both of them being haemoglobin S.

It is also called sickle cell anaemia. It’s a disease where red blood cells take the shape of a crescent or sickle and that change allows them to be more easily destroyed causing anaemia amongst other things. Sickle cell disease is caused by two defective forms of haemoglobin which is the oxygen-carrying component(protein) in red blood cells – one from each parent.

Examples

The inheritance of Hemoglobin S  from each of your parents (S + S =SS ) or inheritance of HbS from one of your parents  with the inheritance  of another abnormal hemoglobin like C, E, D etc from your other parent  ( S+C = SC, S + E = SE, S + D-Punjab=   SD-Punjab )etc or the inheritance of hemoglobin S with beta thalassemia (another blood disorder  that is characterized by a reduction in the production of hemoglobin) S + Beta-thalassemia = SBeta thalassemia

These all indicate you have sickle cell disease.

Sickle cell disease is a life-long illness. The severity of the disease varies widely from person to person. In high-income countries, the life expectancy of a person with SCD is 40–60 years, thanks to advances in the diagnosis and care of SCD. However, in Nigeria, the life expectancy of children born with SCD was found to be as low as 23 years. During this projected lifespan, people with SCD are subjected to unpredictable bouts of intense pain and regular hospitalization. Over a lifetime, SCD can harm a person’s spleen, brain, eyes, lungs, liver, heart, kidneys, joints, bones or skin.

While 70% of the world’s population are carriers, Nigeria has the highest prevalence of sickle cell trait in the world, with 25% of adults being carriers of the trait. Nigeria also accounts for 50% of sickle cell disease (SCD) births worldwide, and of every 1,000 babies born in Nigeria, 20 are born with Sickle Cell Disease, which means that they carry the SS genotype.

We can detect the genotype through blood testing. When selecting a partner hoping to produce children, it is imperative to factor in your hemoglobin genotypes for compatibility.

GENOTYPE COMPATIBILITY

Two partners genotype are said to be compatible when they have no possibility of birthing a child with sickle cell disease. They are said to be incompatible when they can possibly have a child with sickle cell disease.   Genotype AA is the universally compatible genotype.

AA +AA= compatible

AA +AS= compatible

AA + SS = compatible

AA + AC= compatible

AS + AS = incompatible

AS+ AC= incompatible

AS + SS = incompatible

AS + SC = incompatible

SS + SS= Incompatible

AC+ SS= incompatible

SC+ SS= incompatible

AS+Sβ-Thal = incompatible

Anyone with any type of sickle cell disease or sickle cell Trait can only be compatible with marrying someone with genotype AA to avoid having a child sickle cell disease.

SHOULD GENOTYPE GET IN THE WAY OF LOVE?

A lot of people get in serious debates between love and genotype. Well, for those who have been there and are very enlightened they would probably not even regard this as a debate and agree that yes genotype can and should get in the way of love.

Some think genotype compatibility should be the first priority in choosing a life partner while others think only love has the final say.

But then on a general note;

Genotype might not necessarily get in the way of love if both parties have decided to make use of other means to get children like adoption or preimplantation genetic testing. These are other options. So if indeed your love is strong enough to decide not to have biological children for each other; then sure Go for it. In that case love wins which means genotype must not necessarily get in the way of love.

But if your love isn’t that big enough to make such sacrifice and you want kids of your own then it would be of great help to consider all of the possible outcomes as well as reconsidering the relationship if need be because knowing you could have prevented a child from suffering so much all their life but you still let it happen would not even make you enjoy your life or the love which made you get into it in the first place because you would be too busy battling with the sickness of the child or children.

Moreover, do you know how much it costs to maintain just one child living with sickle cell disease not to talk of many? Do you know how expensive it is? Are you also aware the only approved cure for sickle cell disease is not affordable to the majority of people living with the disease? and for those that can afford it, not all of them are able to find a match? Also, for those that have had a transplant done; not all of them have gotten a cure?

Even if it’s only one of your many children that ends up having the disease, that one child doesn’t deserve to be subjected to a life of pain especially when it is your choice to make.

DO NOT BRING A CHILD INTO THE WORLD TO SUFFER!

Moreover, many families eventually end up breaking up because of the challenges of raising or losing children with sickle cell disease. Most of the time, Love eventually fizzles out because of these challenges.

WHY START WHAT YOU CAN’T FINISH?

So, if you do not know your genotype, endeavor to go for a genotype determination test and find out today. More importantly, ensure you run your genotype test in a standard laboratory. If possible, more than one laboratory and more than once for a double check to avoid misdiagnosis. Remember: play your own role in order to break this dreadful sickle cycle.

PREVENTION IS BETTER THAN CURE!

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