Complications and Treatment

If I have thalassemia, how does it affect my body?

Since your body has fewer red blood cells when you have thalassemia, you may have symptoms of a low blood count, or anemia. When you have anemia, you might feel tired or weak. You might also experience:

• Dizziness
• Shortness of breath
• A fast heart beat
• Headache
• Leg cramps
• Difficulty concentrating
• Pale skin

Your body will try very hard to make more red blood cells. The main place where blood cells are made is the bone marrow, the dark spongy part in the middle of bones. Because your bone marrow may be working harder than normal, it might grow bigger. This causes your bones to expand, and may stretch your bones and make them thinner and more easily broken.

Another place where blood is made is an organ called the spleen. It sits on the left side of your abdomen, just under your lower ribs. The spleen has many other jobs. Two of the major ones are filtering the blood and monitoring the blood for certain infections. When it finds these infections, it can start the process of fighting them. When you have thalassemia, the spleen can get very big as it tries to make blood cells. Because it is working so hard on this job, it can’t work as hard to filter blood or monitor for and fight infections. Because of this, people with thalassemia are said to be “immunocompromised,” which means that some of the body’s defenses against infection aren’t working. When you are immunocompromised, it is easier for you to get infections and you sometimes need extra protection, like flu shots and other vaccines.

How is thalassemia treated?

The type of treatment a person receives depends on how severe the thalassemia is. The more severe the thalassemia, the less hemoglobin the body has, and the more severe the anemia may be.

One way to treat anemia is to provide the body with more red blood cells to carry oxygen. This can be done through a blood transfusion, a safe, common procedure in which you receive blood through a small plastic tube inserted into one of your blood vessels. Some people with thalassemia – usually with thalassemia major – need regular blood transfusions because their body makes such low amounts of hemoglobin. People with thalassemia intermedia (not as severe as major, but not as mild as trait) may need blood transfusions sometimes, such as when they have an infection or an illness. People with thalassemia minor or trait usually do not need blood transfusions because they either do not have anemia or have only a mild anemia.

Many times people with thalassemia are prescribed a supplemental B vitamin, known as folic acid, to help treat anemia. Folic acid can help red blood cells develop. Treatment with folic acid is usually done in addition to other therapies.

How do blood transfusions affect my body?

People who receive a lot of blood transfusions are at risk for iron overload. Red blood cells contain a lot of iron, and over time, the iron from all of the transfusions can build up in the body. When it builds up, the iron collects in places like the heart, liver, and brain, and can make it hard for these organs to work properly. To prevent iron overload, people with thalassemia may need chelation therapy, which is when doctors give a medicine – either a pill or a shot under the skin – to remove excess iron before it builds up in the organs.

Every time a person gets a blood transfusion, their risk for a problem called “alloimmunization” goes up. Alloimmunization happens when a person’s body reacts to blood from a transfusion because it is seen as harmful by their immune system, and tries to destroy it. Persons with alloimmunization can still receive blood transfusions, but the blood they receive has to be checked and compared to their own blood to make sure that it won’t be destroyed by their immune system. This takes time and can mean that persons with alloimmunization have to wait longer for blood, or may have a harder time finding blood that won’t be destroyed by their body.

Another concern for people who receive a lot of blood transfusions is the safety of the blood they receive. Some infections, like hepatitis, can be carried in blood. In the United States, the blood supply is screened and monitored for safety, and the risk of getting an infection from a blood transfusion is very low. Nevertheless, there is still a very small risk of getting an infection through a blood transfusion.