International Thalassemia Day 2021: Taking Care Of Thalassemia Patients During These Challenging Times

Thalassemia, one of the most prevalent genetic disorders, affects nearly 200 million people across the world, while in India 10,000 children are born with thalassemia every year which approximately amounts to 10% of the total world prevalence of thalassemia-affected children.

A genetic condition affecting red blood cells, Thalassemia occurs when a person is unable to produce the required amount of haemoglobin, a chemical found in red blood cells which carries oxygen from lungs to all parts of the body. Based on their clinical severity and transfusion requirements, thalassemia syndromes can be classified into three main groups -

1. Transfusion Dependent Thalassemia (TDTs) requires regular blood transfusion for a patient to survive. Without adequate transfusion support, they can suffer several complications and have a short life. This includes beta thalassemia major.

2. Non-transfusion-dependent thalassemia (NTDT) patients do not require lifelong regular transfusions for survival, but they may require occasional or even frequent transfusions in certain clinical settings.

3. Third group includes persons with Thalassemia minor/Trait who have mild anaemia only. They do not need any treatment

International Thalassemia Day 2021: Challenges faced by Thalassemia patients during covid times

With the COVID-19 pandemic straining health systems worldwide, restricted mobility due to lockdowns and fear of contracting the infection from hospital settings, it has become difficult to get blood transfusions for thalassemia patients due to cancellation of blood drives and subsequent decline in the blood reserves. Shortage of staff at health centres is also contributing to the poor care of thalassemia patients.

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Thalassemia is a chronic disease and generally not associated with respiratory diseases but anaemia and iron-overload involving the heart, lungs (pulmonary hypertension), liver, endocrine and even the immune system, can put these patients at higher risk of complications from SARS-CoV-2 infection than the normal population, especially at older age.

Splenectomy, a surgical procedure to remove the spleen, is a common therapeutic intervention beta-thalassemia. At present, there is no evidence to prove that splenectomy is associated with an elevated risk of SARS-CoV-2 viral infection, compared to general population. However, patients who have undergone splenectomy need detailed evaluation for any concomitant bacterial infection, which may happen along with COVID-19 and require antibiotics administration.

Also read: World Thalassemia Day: Symptoms, Causes And Treatment For Thalassemia

Clinics, Thalassemia centres and hospitals should offer patients the safest possible environment for receiving transfusions. Donating blood for thalassemia patients is not dangerous in these epidemic times. Blood bank staff takes care of safety of blood donors and only healthy people with no symptoms of flu are allowed to donate blood. Donating blood does not lower your resistance to infection. If a person has had COVID 19 infection, they can still donate after 28 days of the infection provided, they have recovered completely from disease. COVID 19 vaccination does not prevent from blood donation as well. As per the National Blood Transfusion Council (NBTC) order, a person cannot donate blood till 28 days after taking the last dose of the vaccine but post that, can safely donate blood.

On the other hand, thalassemia patients who become positive for COVID-19 and have moderate to severe disease, then their physician can discontinue their iron chelation therapy for some time after discussion with the family. In such cases, iron chelation should be started once the patient is stable as much comorbidity in thalassemia is related to iron overload. Adherence to the iron chelation dose and the schedule recommended by their care providers will not only reduce organ injury but also complications related to thalassemia.

Also read: World Thalassemia Day 2017: All You Should Know About Thalassemia

Hematopoietic Stem cell (cells giving rise to other blood cells) transplant in transfusion dependent thalassemia is never an emergency. Due to high risk of getting SARS-CoV-2 virus infection in hospital settings during the pandemic and also there being additional risk of complications related to myeloablation (decreased marrow activity resulting in fewer red blood cells, white blood cells and platelets), most allogeneic or genetically dissimilar stem cell transplantation should be postponed in this phase of the pandemic.

(Dr Vipin Khandelwal is Consultant & In charge (Paediatric Haemato-Oncology), Centre for Bone Marrow Transplant at BLK-Max Super Speciality Hospital)

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