Professional Documents
Culture Documents
Presented by:
Arpita Saha
Epidemiology:
Worldwide, 15 million people have clinically
apparent thalassemia disorders. Reportedly,
there are about 240 million carriers of β-
thalassemia worldwide, and in India alone, the
number is approximately 30 million with a
mean prevalence of 3.3%(2,3). They are
encountered among all ethnic groups and in
almost every country around the world.
Pathophysiology of thalassemia
Types of Thalassemia
There are 2 main types of thalassemia:
Alpha thalassemia occurs when a gene or genes related to the alpha globin
protein are missing or changed (mutated).
Beta thalassemia occurs when similar gene defects affect production of the
beta globin protein.
There are many forms of thalassemia. Each type has many different subtypes.
Both alpha and beta thalassemia include the following 2 forms:
Beta-Thalassemia major
Thalassemia major characterized by growth retardation, pallor, jaundice, poor
musculature, hepatosplenomegaly, leg ulcers, skeletal changes resulting
from expansion of bone marrow.
Beta thalassemia intermediate
Present with intermediate severity of anemia and do not required blood
transfusion on regular basis.
Beta-Thalassemia minor
Characterized by mild anemia with elevated level of HbA2 or HbF
Shape of RBC
Clinical Appearance
Curative Preventive
Management Management
Curative
Management
• Rest
• Diet:
Patients/ children are encouraged to avoid high-iron and iron-supplemented
foods, and encouraged to drink tea with meals, which decreases iron
absorption.
Proteins that should be avoided or eliminated from the diet:
Liver
Pork
Beans
Beef
Peanut butter
tofu
Grains that should be avoided or eliminated from the diet:
Infant cereal
Cream of wheat
Fruits/Vegetables that should be avoided or eliminated from the diet:
• Prune juice
• Prunes
• Watermelon
• Spinach
• Leafy green vegetables
• Dates
• Raisins
• Broccoli
• Peas
Treatments for moderate to severe thalassemia
• Treatments for moderate to severe
thalassemia may include:
• Blood transfusions
• People with severe thalassemia require
medical treatment. A blood transfusion
regimen was the first measure effective in
prolonging life.
Outline for transfusion of Blood
• Goals of transfusion
• Basic requirements
– Blood products for transfusion
– Blood storage
– Donor selection and sample testing
– Compatibility testing
• Adverse reactions
– other adverse reactions
– Minimising infection and non-infection risks
– Future approaches to reducing infection risk
• Recommended transfusion regime
– Optimise
• Oxygen carriage
• Supression of IE
– Minimise - Iron loading
When to start transfusion
• Should be based on a definitive diagnosis of severe
thalassemia
• Diagnosis should take into account the molecular defect,
the severity of anaemia on repeated measurement
• The level of ineffective erythropoietin, and clinical criteria
such as failure to thrive or bone changes
• Regular transfusion therapy for severe thalassemia usually
occurs in the first two years of life
• Some patients with milder forms of thalassemia who only
need sporadic transfusions in the first two decades of life
may later need regular transfusions because of a falling
haemoglobin level or the development of serious
complications
Standard Transfusion Regimen for Thalassemia Major
Regular blood transfusions administered every 2-5 weeks
Maintain the pre-transfusion Hb > 9-10.5g/dl
• Rationale
– promotes normal growth
– allows normal physical activities
– adequately suppresses bone marrow activity in most patients
– minimises transfusional iron accumulation [Cazzola 1995,1997]
• Modifications
– A higher target 11-12 g/dl may be appropriate for patients with heart
disease or other medical conditions and for those patients who do not
achieve adequate suppression of bone marrow activity at the lower
haemoglobin level.
– Although shorter intervals between transfusions may reduce overall blood
requirements, the choice of interval must take into account other factors
such as the patient’s work or school schedule
Compatibility Testing
• Before embarking on transfusion therapy
– patients should have extended red cell antigen typing
– at least C, c, E, e.
• Blood selection
– transfused with ABO and Rh(D) compatible blood.
– Some clinicians recommend the use of blood that is also matched for at
least the C, E and antigens in order to avoid alloimmunisation against
these antigens.
– Some centres use even more extended antigen matching.
• Before each transfusion
– it is necessary to perform a full crossmatch and screen for new
antibodies
• If new antibodies appear, they must be identified so that blood missing the
corresponding antigen(s) can be used
• A complete record of
– antigen typing,
– red cell antibodies and transfusion reactions
– should be readily available if the patient is transfused at a different
centre.
• Transfusion of blood from first-degree relatives should be avoided because
of the risk of developing antibodies that might adversely affect the outcome
of a later bone marrow transplant
Adverse reactions
Doses :
• 20 mg/kg PO QDS; may increase by 5-10 mg
increments based on serum ferritin; if not
controlled on 30 mg/kg/day (ie, serum ferritin
persistently >2500 mcg/L), may increase up to 40
mg/kg QDS.
• Common side effects include: nausea, vomiting
and diarrhea.
Bone marrow transplant
• Bone marrow transplantation may offer the
possibility of a cure in young people who have an
HLA-matched donor. Success rates have been in the
80–90% range. Mortality from the procedure is about
3% .
• If the person does not have an HLA-matched
compatible donor, another method called bone
marrow transplantation (BMT) from haploidentical
mother to child (mismatched donor) may be used.
• mortality 7%.
Nursing Management:
Rest:
Diet:
• Physical Examination:
• On clinical assessment children will show gross clinical features
Subjective data:
• There should always inquire about the patient's ethnic background, family history
of hematologic disorders, and dietary history as this is a heterogenous group of
heritable disease.
• An affected child's parents or caregivers may report history of pallor, abdominal
distension of child, anorexia, activity intolerance.
Objective data:
• Assessment for following:
• Severe anemia, with an Hb level of 3-7g/dL., pallor, fatigue.
• Massive hepatosplenomegaly, distended abdomen.
• Severe growth retardation.
• Bony deformities
• Observation for sign of hemosidarosis.
Nursing Diagnosis: