Microcytic, target cells, NORMAL iron studies; ethnicity
Most accurate: Hemoglobin electrophoresis (↑HbA₂/HbF in β-thalassemia)
Minor → none. Major → chronic transfusion + iron chelation (deferasirox/deferoxamine); luspatercept reduces transfusion burden in transfusion-dependent β-thalassemia
Order set
- FBC, film
- Hb electrophoresis/HPLC
- Iron studies (to exclude deficiency)
Criteria
AdmitSevere anaemia / aplastic or haemolytic crisis
TransfuseSymptomatic anaemia per programme
DischargeStable Hb, transfusion/chelation plan
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
- Transfusion-dependent anaemia
- Iron overload signs
Differentials
- Iron deficiency
- Sideroblastic anaemia
Common mistakes
- Giving iron unnecessarily
- Missing coexisting deficiency
Disposition & follow-up
Genetic counselling; major → transfusion + chelation program.
Discharge package
MedicationsFolate; chelation if iron-loaded
Follow-upHaematology programme
VaccinationPer hyposplenism if splenectomised
Warning symptomsWorsening anaemia symptoms
💊 Treatment detail — doses & preparation
Chronic transfusionsupportive
DoseRegular PRBC to maintain Hb ~90–105 g/L (thalassaemia major)
PreparationCrossmatched, leucodepleted units
MonitorIron loading tracked by ferritin/MRI
Deferasiroxiron chelator
Dose10–30 mg/kg OD (transfusion overload)
Preparation90–360 mg tablets on empty stomach
MonitorCreatinine, LFTs monthly; GI upset, rash
Folic acidvitamin
Dose5 mg OD (deficiency/methotrexate cover — give on non-MTX days)
Preparation5 mg tablets
MonitorCorrect B12 deficiency FIRST if coexisting
📖 BSH / TIF ThalassaemiaReviewed July 2026