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(Mediterranean Anemia; Thalassemia Major and Minor)


Evan M. Braunstein

, MD, PhD, Johns Hopkins University School of Medicine

Reviewed/Revised Jul 2022 | Modified Sep 2022

Thalassemias are a group of inherited disorders resulting from an imbalance in the production of one of the four chains of amino acids that make up hemoglobin (the oxygen-carrying protein found in red blood cells).

  • Symptoms depend on the type of thalassemia.

  • Some people have jaundice and abdominal fullness or discomfort.

  • Diagnosis usually requires special hemoglobin tests.

  • Mild thalassemia may not require treatment, but severe thalassemia may require bone marrow transplantation.

Hemoglobin is made up of two pairs of globin chains. Normally, adults have one pair of alpha chains and one pair of beta chains. Sometimes one or more of these chains is abnormal. Thalassemias are categorized according to the amino acid chain affected. The two main types are

  • Alpha-thalassemia (the alpha globin chain is affected)

  • Beta-thalassemia (the beta globin chain is affected)

Alpha-thalassemia is most common in people with African or Black American, Mediterranean, or Southeast Asian ancestry. Beta-thalassemia is most common in people of Mediterranean, Middle Eastern, Southeast Asian, or Indian ancestry.

Thalassemias can be classified according to how severe they are.

  • Thalassemia minor: Causes no symptoms or mild symptoms

  • Thalassemia intermedia: Causes symptoms that are between mild and severe

  • Thalassemia major: Causes severe symptoms that require treatment

Symptoms of Thalassemias

All thalassemias have similar symptoms, but they vary in severity.

In alpha-thalassemia minor and beta-thalassemia minor, people have mild anemia with no symptoms.

In alpha-thalassemia major, people have moderate or severe symptoms of anemia, including fatigue, shortness of breath, paleness, and an enlarged spleen Enlarged Spleen An enlarged spleen is not a disease in itself but the result of an underlying disorder. Many disorders can make the spleen enlarge. Many disorders, including infections, anemias, and cancers... read more , which leads to a feeling of fullness and abdominal discomfort.

In beta-thalassemia major (sometimes called Cooley anemia), people have severe symptoms of anemia, such as fatigue, weakness, and shortness of breath, and they may also have jaundice Jaundice in Adults In jaundice, the skin and whites of the eyes look yellow. Jaundice occurs when there is too much bilirubin (a yellow pigment) in the blood—a condition called hyperbilirubinemia. (See also Overview... read more Jaundice in Adults , causing yellowing of the skin and whites of the eyes, skin ulcers, and gallstones Gallstones Gallstones are collections of solid material (predominantly crystals of cholesterol) in the gallbladder. The liver can secrete too much cholesterol, which is carried with bile to the gallbladder... read more . People may also have an enlarged spleen. Overactive bone marrow may cause some bones, especially those in the head and face, to thicken and enlarge. The long bones in the arms and legs may weaken and fracture easily.

Children who have beta-thalassemia major may grow more slowly and reach puberty later than they normally would. Because iron absorption may be increased and frequent blood transfusions (providing even more iron) are needed, excessive iron may accumulate and be deposited in the heart muscle, eventually causing iron overload Overview of Iron Overload Iron is essential for life, so the body usually tightly controls iron absorption from food and recycles the iron from red blood cells. People lose small amounts of iron every day, and even a... read more disease and heart failure and early death.

Diagnosis of Thalassemias

  • Blood tests

  • Hemoglobin electrophoresis

  • Prenatal testing

Blood tests are done for diagnosis of thalassemia. Doctors measure blood counts and examine a sample of blood under a microscope. Characteristic abnormalities of the red blood cells can be seen.

Hemoglobin electrophoresis Diagnosis Sickle cell disease is an inherited genetic abnormality of hemoglobin (the oxygen-carrying protein found in red blood cells) characterized by sickle (crescent)-shaped red blood cells and chronic... read more Diagnosis , another blood test, is also done. In electrophoresis, an electrical current is used to separate the different types of hemoglobin and thus detect abnormal hemoglobin. Testing a drop of blood by electrophoresis is helpful but may be inconclusive, especially for alpha-thalassemia. Therefore, the diagnosis is usually based on special hemoglobin tests and determination of hereditary patterns.

Genetic testing can be done to detect thalassemias before birth.

Treatment of Thalassemias

  • Sometimes blood transfusions, removal of the spleen, or iron chelation therapy

  • Stem cell transplantation

Most people who have a mild thalassemia do not need treatment.

People who have more severe thalassemia may need to have surgery to remove the spleen (splenectomy), blood transfusions Overview of Blood Transfusion A blood transfusion is the transfer of blood or a blood component from one healthy person (a donor) to a sick person (a recipient). Transfusions are given to increase the blood's ability to... read more Overview of Blood Transfusion , or iron chelation therapy. In chelation therapy, excess iron is removed from the blood. Drugs called iron chelators may be given by mouth (deferasirox or deferiprone) or by an infusion (deferoxamine), which can be given under the skin (subcutaneous) or into a vein (intravenous).

Luspatercept may be given to reduce the need for blood transfusions in people with beta-thalassemia.

More Information

The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

Drugs Mentioned In This Article

Generic Name Select Brand Names
Exjade, Jadenu
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