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Premarital haemoglobinopathy screening: what couples should know | CION Cancer Clinics
Both partners should have a blood count and haemoglobin HPLC test before marriage or pregnancy. If only one of you carries thalassaemia or sickle cell trait, your children cannot inherit the serious form. If both of you do, each pregnancy carries a 1 in 4 chance, and knowing early gives you options. This guide explains the test, the report and its limits. At CION Cancer Clinics, our haematologist cares for anaemia, bleeding, clotting and inherited blood disorders, with ArogyaSri, CGHS and cashless insurance accepted.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- Should both of you be tested before the wedding?
- Which carrier states does the screening pick up?
- How does premarital screening actually work?
- What do the words on the screening report mean?
- What does your result as a couple mean for children?
- What do families often get wrong about carrier testing?
- What can this screening not tell you?
- Common questions about premarital thalassaemia screening
The short answer
Should both of you be tested before the wedding?
Yes. A simple blood test for both partners, done before marriage or before planning a pregnancy, shows whether either of you carries thalassaemia or another inherited haemoglobin change. If only one of you is a carrier, your children cannot be born with the serious form. If both of you are, each pregnancy carries a real chance, and you want to know that early.
What being a carrier means
A carrier has one changed haemoglobin gene and one normal one. Most carriers feel completely well. Your report may say "trait" or "minor". The only sign is often slightly small red cells on a routine blood count, which is easily mistaken for low iron. That is why people learn they are carriers only after a child is diagnosed.
Why this matters so much in India
Thalassaemia and sickle cell carriers are common across India, and more common in some communities and regions than others. Marriage within a community or a family raises the chance that both partners carry the same change. Testing costs far less, in money and in grief, than learning after the birth.
Who should not wait
Anyone with a relative who has thalassaemia, sickle cell disease or regular blood transfusions. Anyone told they have "low haemoglobin" that did not improve with iron. And any couple already expecting a baby, who should ask for the test at the first antenatal visit.
What the test looks for
Which carrier states does the screening pick up?
One sample is checked for several changes at once. These are the ones that matter most for couples in Telangana and Andhra Pradesh.
Beta thalassaemia trait
The most common carrier state behind thalassaemia major in India. It usually shows as small red cells and a raised level of a minor haemoglobin called HbA2.
Matters if your partner carries
- Beta thalassaemia trait
- HbE or sickle cell trait
Sickle cell trait (HbS)
Common in several tribal and rural communities, including parts of Telangana and Andhra Pradesh. Carriers are usually well. Two carriers together can have a child with sickle cell disease.
HbE and HbD
Other haemoglobin variants that are harmless on their own. Paired with beta thalassaemia trait in the other partner, they can lead to a child needing lifelong care.
Alpha thalassaemia trait
Harder to see on the standard test. Many alpha carriers look normal or show only small red cells, so a DNA test is sometimes needed.
Ask about this if your red cells are small, your iron is normal and HbA2 is not raised.Not sure whether this applies to you?
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How does premarital screening actually work?
One blood sample each
A small sample from the arm. You do not need to fast. Tell the laboratory if you have had a blood transfusion in recent months, because donated blood changes the result and the test may need to wait.
Blood count and HPLC
The laboratory runs a complete blood count and a test called HPLC, which sorts your haemoglobin into its types. Together they show most carrier states. Iron levels are often checked at the same time.
A doctor reads both reports together
Your result only means something alongside your partner's. A haematologist or genetic counsellor reads the two side by side and tells you whether your pair carries any risk for children.
DNA testing, only if needed
If a result is borderline, or both of you carry a change, a DNA test pins down the exact gene change. That detail is what makes testing a future pregnancy possible.
On your report
What do the words on the screening report mean?
- MCV and MCH
- The size of your red cells and how much haemoglobin each one holds. Low values raise the question of a carrier state or low iron.
- HPLC
- The laboratory test that separates the different types of haemoglobin in your blood and measures each one.
- HbA2
- A minor type of haemoglobin. A raised level is the usual sign of beta thalassaemia trait. Low iron can pull it down and hide the trait.
- HbF
- Foetal haemoglobin, the type a baby makes before birth. Small amounts in adults are normal; higher amounts are noted and explained.
- HbS, HbE, HbD
- Variant haemoglobins. Seeing one on the report means you carry that variant, not that you have a disease.
- Trait or minor
- Both mean carrier. They do not mean you are ill or will become ill.
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Reading the pair
What does your result as a couple mean for children?
Your result as a couple
What it means for a pregnancy
Neither partner is a carrier
No known risk from these conditions
Only one partner is a carrier
A child may be a carrier, but cannot have the serious form
Both carry beta thalassaemia trait
A 1 in 4 chance of thalassaemia major in each pregnancy
One beta trait, one HbE or sickle cell trait
A real chance of a serious combined disorder; see a counsellor
A result is borderline or unclear
Repeat after iron is corrected, or a DNA test
Commonly believed
What do families often get wrong about carrier testing?
"We are both healthy, so our children will be fine."
Carriers are healthy by definition. Two well parents who both carry the trait can still have a child with thalassaemia major. Feeling well tells you nothing about carrier status. Only the blood test does.
"A normal haemoglobin means I am not a carrier."
Many carriers have a haemoglobin level in the normal range. The clue is in the red cell size and the HPLC result, not the haemoglobin figure. A routine blood count alone can miss it.
"If one of us is a carrier, the marriage should not happen."
One carrier partner does not put children at risk of the serious form. Even when both are carriers, couples have options, including testing during pregnancy. The result is information for planning, not a reason to call off a marriage.
"The iron tablets fixed it, so it was only low iron."
Low iron and carrier status often exist together. Iron can lift the haemoglobin while the trait stays. If your red cells stay small after iron, ask for HPLC.
Being straight with you
What can this screening not tell you?
A screening result tells you about carrier status for the common haemoglobin changes. It does not test for every inherited blood condition, and it does not tell you anything about cancer or other illnesses.
It can miss some carriers
Low iron, a recent transfusion or a silent alpha change can hide a carrier state. Reference ranges also differ between laboratories, so one report is read alongside the other partner's result, your iron studies and, sometimes, a repeat test. If something does not add up, a DNA test is the next step, not a guess.
It is not a decision about your marriage
The test gives you facts. What you do with them is a private decision for the two of you, ideally made after proper genetic counselling. Share the result with family only when you are ready, and only with people who need it.
Where CION fits in
CION's haematology team, led by Dr. Basudev Pokhrel, can read your reports with you, explain what your pair means, and help you reach counselling and DNA testing at a qualified laboratory. Bring both partners' reports to that conversation.
Questions we are asked
Common questions about premarital thalassaemia screening
Which test should we ask the laboratory for?
Ask for a complete blood count with red cell indices and haemoglobin HPLC, for both partners. Some laboratories call it a thalassaemia or haemoglobinopathy screen. An iron test alongside helps explain borderline results. A plain haemoglobin figure on its own is not enough to rule out a carrier state.
Is it too late if we are already married?
No. Testing is useful at any time before a pregnancy, and still useful early in a pregnancy. If you are already expecting, tell your obstetrician and ask for both of you to be tested straight away, because testing the baby has to happen within a limited window.
I am a carrier. Do I need treatment?
Usually not. Carriers generally live normal, healthy lives. Your blood count may always look slightly unusual, so tell every new doctor you are a carrier. Do not take iron tablets for small red cells unless a test shows your iron is actually low, because extra iron you do not need can do harm.
Can the result change if we test again later?
Your carrier status is inherited and does not change. What can change is how clearly the test shows it. Low iron or a recent transfusion can blur the result, so a repeat after those are sorted out may give a clearer answer than the first report.
My partner's family does not want the test done. What now?
This is common, and often comes from fear of stigma. It may help to explain that the test is about planning healthy children, not judging anyone. A genetic counsellor can speak to both families together. The test itself needs only your partner's own consent.
Does being a carrier affect pregnancy for the mother?
Most carrier mothers go through pregnancy without problems, though haemoglobin can drop more than usual. Tell your obstetrician you are a carrier so that iron is checked properly before any iron is prescribed. The bigger question is the baby's status, which depends on the father's result too.
Should our brothers and sisters get tested too?
Yes, it is sensible. If you are a carrier, your brothers, sisters and cousins have a higher chance of carrying the same change. Testing them before they marry gives them the same chance to plan that you now have. Share the result gently and let each person decide.
Is screening covered by any government programme?
Some states and the national sickle cell programme run free or low-cost screening, especially in communities where sickle cell is common. What is offered changes over time and differs by district, so check with your nearest government hospital or health worker for the current rules before paying privately.
Your Haematologist
Meet CION's haematologist. One specialist for your blood report and your plan.
Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Where to find us
Our centres in and around Hyderabad
Addressed by landmark, because that is how this city navigates. A haematology consultation can be booked at any of these centres through one helpline, and your team will tell you where each test or treatment takes place.
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Sources
- NHS — Thalassaemia
- NHS — Sickle cell disease
- NHLBI — Thalassemias
- NHS — Screening for sickle cell and thalassaemia in pregnancy
- National Health Mission — National Sickle Cell Elimination Mission
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Both Partners Are Carriers: What the Odds MeanIf both your reports show a carrier stateGenetic Counselling for Haemoglobin DisordersWhat a counsellor explains and how to preparePrenatal Diagnosis for Thalassaemia and Sickle CellTesting a pregnancy when both partners carryTesting Siblings and Extended FamilyWho else in the family should be testedCarrier Screening and Genetic CounsellingThe full guide to carrier testing
Talk to us
Have both screening reports in hand?
Share them with us. CION's haematology team will explain what your results mean as a couple and help you reach counselling or DNA testing if you need it.