Thalassemia in Refugee Patients
Overview
Thalassemia variants are common in refugees from Africa, the Mediterranean, and Asia. They are detected on routine hemoglobinopathy screening.
Important: Always wait for the complete hemoglobinopathy screen before interpreting MCV. Thalassemia trait causes microcytosis even without iron deficiency.
Alpha-Thalassemia
Caused by deletions in 1-4 of the alpha globin genes.
Genotype | Missing Genes | Clinical Effect | Management |
Silent carrier | 1 | Asymptomatic, normal CBC | No treatment. Genetic counselling if planning pregnancy. |
Alpha-thal trait | 2 | Mild anemia, microcytosis | No treatment. Genetic counselling if planning pregnancy. |
Hemoglobin H disease | 3 | Moderate to severe anemia | Refer to Hematology. Folic acid 1-2 mg daily. Avoid iron supplements unless iron deficient. |
Hydrops fetalis | 4 | Incompatible with life | Genetic counselling essential pre-pregnancy |
If a patient has any alpha-thal allele and is planning a pregnancy: test the partner. If there is risk of Hb H disease or hydrops fetalis in the fetus, refer to Medical Genetics.
Beta-Thalassemia
Caused by mutations reducing or eliminating beta globin expression.
Type | Clinical Effect | Management |
Beta-thal minor | Mild anemia, marked microcytosis | No treatment. Usually asymptomatic. |
Beta-thal intermedia | Moderate anemia, may need transfusions | Refer to Hematology |
Beta-thal major | Severe transfusion-dependent anemia | Refer to Hematology. Usually already diagnosed. |
If a patient has any beta-thal allele and is planning a pregnancy: test the partner. If there is risk of beta-thal major or intermedia in the fetus, refer to Medical Genetics.