For thalassemia major, when would my son require his first blood transfusion?

Question

Hello doctor,

My son is 15 months old and has been diagnosed with thalassemia major. My only question is when he would require his first blood transfusion? Because typically people feel strong symptoms of anemia and need medical help when Hb goes below 6. But, my child has Hb of 3.7 probably for over a month and two weeks have passed till the last testing, and he looks normal. I want to know how he is surviving at this low Hb. He plays well, sleeps well and walks in a walker and from today, he started taking a few steps on his own. Is this because of HbF, which is 96%? If so, then till what age HbF will be produced in his body? I have read about treatments for thalassemia people in which medicines are given to increase HbF production and by this many people do not have to go for BT. Is this a viable option or should I go for BT for my child?

Answer 1

Hi,

Welcome to icliniq.com. I can understand your concerns. The definite management of thalassemia is bone marrow transplant. For this HLA - human leukocyte antigen) matching is done and if possible this is the best treatment available right now. The second one is a regular blood transfusion. We usually keep hemoglobin levels between 9.5 to 10.5 g/dL. It is necessary to maintain hemoglobin levels at this levels so that complications like bone changes, endocrine changes and effects of the heart are minimized. Along with this iron chelator drugs are given. Hemoglobin of 3.7 g/dL requires immediate blood transfusion. Third, there are some new drugs which increase hbF levels and decrease blood transfusion requirement. But, this is in the experimental stage. I suggest you get transfusion for your child immediately.