SEVERE THALASSEMIA-INTERMEDIA - CLINICAL PROBLEMS IN THE ABSENCE OF HYPERTRANSFUSION

In many of the parts of the world where thalassaemia is common, the bl ood supply is inadequate or unsafe, and desferrioxamine is too expensi ve for routine use. We classify some patients as having 'severe thalas saemia intermedia', i.e, those with moderately severe thalassaemia who can survive without regular transfusions, but who are at risk of many complications which are reviewed here. These include bone deformity a nd fractures, extramedullary haemopoietic tumours, leg ulcers, autoimm une haemolysis and, especially after splenectomy, thromboembolism and infection. An increase in the quality and safety of the blood supply, and a cheaper and/or oral iron chelator, would enable more of these pa tients to be treated as thalassaemia major and have improved survival and quality of life.