Topic Overview

What is thalassemia?

Thalassemia (say
“thal-uh-SEE-mee-uh”) is an inherited blood disorder that causes your body to
make less
hemoglobin or abnormal hemoglobin.
Hemoglobin helps red blood cells spread oxygen through
your body. Low levels of hemoglobin may cause
anemia, an illness that makes you feel weak and tired.
Severe anemia can damage organs and lead to death.

What are the types of thalassemia?

There are two main types:
alpha and beta. Beta thalassemia is the most common.

Beta thalassemia

You need both alpha- and
beta-globin to make hemoglobin. Beta thalassemia occurs when one or both of the
two genes that make beta-globin don’t work or only partly work as they should.

  • If you have one damaged gene, you
    may have mild anemia and probably won’t need treatment. This is
    called beta thalassemia minor or beta thalassemia trait. It happens when you get a normal gene from one
    parent and a thalassemia gene from the other.
  • When both
    genes are damaged, it means you got a thalassemia gene from each
    parent. You may have moderate or severe anemia.

    • If you have moderate anemia (beta thalassemia intermedia), you may need
      blood transfusions.
    • People with severe anemia (called
      beta thalassemia major or Cooley’s anemia) need blood transfusions throughout life. Symptoms
      of anemia usually begin within a few months after birth.

Alpha thalassemia

This type occurs when
one or more of the four alpha-globin genes that make hemoglobin are missing or
damaged.

  • If one gene is missing or damaged: Your red blood cells might be smaller than normal. You will have no symptoms and you will not
    need treatment. But you are a silent carrier. This means
    you don’t have the disease but can pass the defective gene to your child.
  • If two genes are missing or damaged: You will have very mild
    anemia that will typically not need treatment. This is called
    alpha thalassemia minor or alpha thalassemia trait.
  • If three genes are missing: You will have mild to moderately severe
    anemia. This is sometimes called hemoglobin H disease.
    If it is severe, you may need blood transfusions.
  • If all four genes are missing: This is called alpha thalassemia major or hydrops fetalis. The fetus will be stillborn, or the
    child will die soon after birth.

What causes thalassemia?

A defect in one or more
genes causes thalassemia.

If you, either parent, or any of your siblings have thalassemia or carry a gene for thalassemia and you’re thinking about
having a child, you may want to talk to a genetic counselor before you get pregnant. A genetic counselor can tell you
how likely it is that your child will have the disease and how severe it might
be.

What are the symptoms?

Mild thalassemia usually
doesn’t cause any symptoms.

Moderate or severe
disease may cause symptoms of anemia. For example, you may feel weak, tire out more easily, and feel short of breath. Other symptoms also can occur depending on how severe your disease is and what problems it causes.

Children with severe thalassemia may grow slowly (failure to thrive), have skull bones that are not shaped normally, and have problems with feeding, frequent fevers, and diarrhea.

How is thalassemia diagnosed?

Your doctor will do an exam and ask about your health history. Tests
you may need include:

  • A
    complete blood count (CBC).
  • A
    gene test to see if you have the genes that cause thalassemia.
  • An iron level test.
  • A blood test that
    measures the amounts of different types of hemoglobin, to help find out which
    type of thalassemia you have.

If you learn that you have thalassemia, your family members should to talk to their doctors about testing.

How is it treated?

Treatment depends on how severe your condition is.

Most large medical centers have treatment centers for blood disorders. They are an excellent resource to help you and your family get the best care.

  • Mild thalassemia, the most common form, does
    not need treatment.
  • Moderate thalassemia may be treated with
    blood transfusions and folic acid supplements. Folic acid is a vitamin that your body needs to produce red blood cells.
  • Severe thalassemia may
    be treated with:

    • Blood transfusions.
    • Folic
      acid.

If you have repeated blood transfusions, it’s possible
for your body to get too much iron. This can
damage your heart and other organs. Make sure to avoid vitamins that contain iron, and don’t take extra vitamin C, which can increase how much iron you absorb from food. If you have too much
iron, your doctor may give you
chelation therapy. This is a medicine that helps remove iron from your body.

Less common treatments for severe thalassemia include:

Get a flu vaccine each year. Also talk to your
doctor about getting a pneumococcal vaccine. These vaccines may protect you from severe
infections, which can make
anemia worse and cause severe illness in people who have thalassemia.

Other Places To Get Help

Organization

Centers for Disease Control and Prevention (CDC): Blood Disorders (U.S.)
www.cdc.gov/ncbddd/blooddisorders/index.html

References

Other Works Consulted

  • Borgna-Pignatti C, Galanello R (2009). Thalassemias and related disorders: Quantitative disorders of hemoglobin synthesis. In JP Greer et al., eds., Wintrobe’s Clinical Hematology, 12th ed., vol. 1, pp. 1083-1131. Philadelphia: Lippincott Williams and Wilkins.
  • Hillman R, et al. (2011). Thalassemia. In Hematology in Clinical Practice, 5th ed., pp. 65-78. New York: McGraw-Hill.
  • Pennell DJ, et al. (2013). Cardiovascular function and treatment in ß-thalassemia major: A consensus statement from the American Heart Association. Circulation, 128(3): 281-308.
  • Weatherall DJ (2010). The thalassemias: Disorders of globin synthesis. In K Kaushansky et al., eds., Williams Hematology, 8th ed., pp. 675-707. New York: McGraw-Hill.

Credits

ByHealthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD – Internal Medicine
Adam Husney, MD – Family Medicine
Martin J. Gabica, MD – Family Medicine
Specialist Medical Reviewer Brian Leber, MDCM, FRCPC – Hematology

Current as ofOctober 9, 2017