Family history and ancestry are the two risk factors for thalassemias.
Family History
Thalassemias are inherited—that is, they're passed from parents to children through the genes. If your parents have missing or altered hemoglobin-making genes, you may have thalassemia.
Ancestry
Alpha thalassemias most often affect people of Southeast Asian, Indian, Chinese, or Filipino origin or ancestry.
Beta thalassemias most often affect people of Mediterranean (Greek, Italian, and Middle Eastern), Asian, or African origin or ancestry.
What Are the Signs and Symptoms of Thalassemias?
A lack of oxygen in the bloodstream causes the signs and symptoms of thalassemias. The lack of oxygen occurs because the body doesn't make enough healthy red blood cells and hemoglobin. The severity of symptoms depends on the severity of the disorder.
No Symptoms
Alpha thalassemia silent carriers generally have no signs or symptoms of the disorder. This is because the lack of alpha globin protein is so minor that the body's hemoglobin works normally.
Mild Anemia
People who have alpha or beta thalassemia trait can have mild anemia. However, many people who have these types of thalassemia have no signs or symptoms.
Mild anemia can make you feel fatigued (tired). Mild anemia caused by alpha or beta thalassemia trait often is mistaken for iron-deficiency anemia.
Mild to Moderate Anemia and Other Signs and Symptoms
People who have beta thalassemia intermedia have mild to moderate anemia. They also may have other health problems, such as:
- Slowed growth and delayed puberty. Anemia can slow down a child's growth and development.
- Bone problems. Thalassemia may cause bone marrow to expand. Bone marrow is the spongy substance inside bones that makes blood cells. When bone marrow expands, the bones become wider than normal. They may become brittle and break easily.
- An enlarged spleen. The spleen is an organ that helps your body fight infection and remove unwanted material. When a person has thalassemia, the spleen has to work very hard. As a result, the spleen becomes larger than normal. This makes anemia worse. If the spleen becomes too large, it must be removed.
Severe Anemia and Other Signs and Symptoms
People who have hemoglobin H disease or beta thalassemia major (also called Cooley's anemia) have severe thalassemia. Signs and symptoms occur within the first 2 years of life. They may include severe anemia and other health problems, such as:
- A pale and listless appearance
- Poor appetite
- Dark urine (a sign that red blood cells are breaking down)
- Slowed growth and delayed puberty
- Jaundice (a yellowish color of the skin or whites of the eyes)
- An enlarged spleen, liver, and heart
- Bone problems (especially bones in the face)
Complications of Thalassemias
Better treatments now allow people who have moderate and severe thalassemias to live much longer. As a result, these people must cope with complications of these disorders that occur over time.
Heart and Liver Diseases
Regular blood transfusions are a standard treatment for thalassemias. As a result, iron can build up in the blood (iron overload). This can damage organs and tissues, especially the heart and liver.
Heart disease caused by iron overload is the main cause of death in people who have thalassemias. Heart disease includes heart failure, arrhythmias (irregular heartbeats), and heart attack.
Infection
Among people who have thalassemias, infections are a key cause of illness and the second most common cause of death. People who have had their spleens removed are at even higher risk because they no longer have this infection-fighting organ.
Osteoporosis
Many people who have thalassemias have bone problems, including osteoporosis (OS-te-o-po-RO-sis). This is a condition in which bones are weak and brittle and break easily.
