Pediatric Beta Thalassemia

Beta thalassemia is an inherited blood disorder. This means it is passed down through the parent’s genes. It is a form of anemia. Anemia is a low red blood cell or low hemoglobin level. Hemoglobin is part of red blood cells. It carries oxygen to organs, tissues and cells. Beta thalassemia affects the production of hemoglobin.

There are different types of thalassemia. The severity of anemia depends on the type of your child has.

Beta thalassemia is caused by a defect of the gene that controls hemoglobin production. There are three types:

• Beta thalassemia major (Cooley's anemia). This is the most severe type of beta thalassemia. It is often found during the first two years of life. Children often need frequent blood transfusions. This can cause serious problems with iron overload. 
• Beta thalassemia intermedia. This type of thalassemia is common throughout the world. It may also be caused by abnormal hemoglobin. Or more than one type of abnormal hemoglobin may be present. It is often found later than beta thalassemia major. Transfusions are usually not needed.
• Thalassemia minor or thalassemia trait. These are the carriers of beta thalassemia.

The symptoms of beta thalassemia major occur when an infant is between six and 24 months. They include:

• Poor growth and development
• Pale skin
• Feeding problems
• Diarrhea
• Irritability, fussiness
• Fevers
• Enlarged abdomen from enlarged spleen

The symptoms of beta thalassemia intermedia happen at a later age and include:

• Pale or yellow skin
• Gallstones
• Enlarged liver and spleen
• Bone changes
• Leg ulcers or sores
• Soft bones

Children with beta thalassemia minor have anemia, but often do not have symptoms.

The health care provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam. Your child may also have tests, such as:

• Complete blood count (CBC). A complete blood count checks the red and white blood cells, blood clotting cells (platelets) and sometimes young red blood cells. It includes hemoglobin, hematocrit and more details about the red blood cells.
• Peripheral smear. A small sample of blood is checked under a microscope to see if they look abnormal.
• Hemoglobin electrophoresis. This test measures the types and amount of hemoglobin.
• Iron studies. These studies check for iron deficiency anemia.
• DNA testing. These tests look for gene defects. DNA testing can find alpha thalassemia carriers.

Beta thalassemia is an inherited problem. It is passed from parents to children.

• Thalassemia major is inherited when two carrier parents who have thalassemia minor pass it on to their child. Each child of two carrier parents has a 25% of having beta thalassemia major.
• Thalassemia minor is inherited when two carrier parents pass it on to their child. Each child of two carrier parents has a 50% chance of having beta thalassemia minor.

The gene defect that causes beta thalassemia is more common in the following people:

• Greek
• Italian
• Middle Eastern
• Asian
• African

Complications from frequent transfusions may happen when a child is about 10 or 11 years old. They are from having too much iron. The complications include:

• Delayed growth and development, including sexual development
• Heart, liver and spleen problems
• Endocrine system problems (for example, diabetes or thyroid problems)
• Blood clots
• Osteoporosis

Children with beta thalassemia intermedia may also have complications from iron overload.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is.

Your child's health care provider will likely send you to a hematologist. This is an expert in blood disorders. Treatment for beta thalassemia depends on the type. It may include:

• For beta thalassemia major:
• Regular blood transfusions (your child gets healthy blood from a donor)
• Your child needs to have completed the hepatitis B vaccine series.
• Medicines (to cut amount of iron in the body, called chelation therapy)
• Stem cell or cord blood transplant
• Other therapies are under study, including gene therapy.
• For beta thalassemia intermedia:
• Possible blood transfusions
• Removal of the spleen
• Daily doses of folic acid, a vitamin needed to make hemoglobin

Each child's symptoms and treatment is different. Make sure you understand your child's symptoms and treatment, including possible side effects. Call your child's provider if you notice any changes or have questions. For example, call the provider if your child has any of the following:

• Slowed growth or development
• Feeding problems
• Fussiness
• Fevers