Understanding Thalassemia: The Basics 

Thalassemia is an inherited blood disorder in which your body doesn’t produce enough healthy hemoglobin, a protein in red blood cells that carries oxygen throughout your body. Think of hemoglobin as a delivery service – when it’s not working properly, oxygen doesn’t reach the body’s tissues effectively, which means organs can’t function as they should. Because of this, people with thalassemia often feel very tired, weak, and may look pale. In children, it can also slow down growth and development. Managing thalassemia is important for keeping energy levels up and supporting overall health.

Types of Thalassemia

Hemoglobin is made up of 2 kinds of protein chains: Alpha-globin and Beta-globin. Based on which of these proteins is affected, thalassemia can be divided into two main types: alpha-thalassemia and beta-thalassemia. The prevalence of each type varies by region. Alpha-thalassemia is more common among people of Southeast Asian, Middle Eastern, Chinese, and African descent, while beta-thalassemia is more prevalent in Mediterranean populations. Each type has subtypes that range in severity.

1. Alpha-Thalassemia:

The alpha protein chains of hemoglobin are made from four alpha-globin genes. The severity of alpha-thalassemia depends on how many of these genes are affected:

• Silent Carrier State: Only one abnormal alpha-globin gene is present. This generally causes no symptoms, and blood tests are usually normal, although red blood cells may be slightly smaller than average. Silent carriers can pass the gene mutation to their children.
• Alpha-Thalassemia Minor: Two abnormal alpha-globin genes are present. People with this type may experience mild anemia.
• Hemoglobin H Disease: Three abnormal alpha-globin genes are affected. This form is more serious and can lead to moderate to severe anemia. Blood transfusions are often required to manage symptoms.
• Alpha-Thalassemia Major (Hydrops Fetalis): All four alpha-globin genes are abnormal, leaving no normal genes. This is the most severe form of alpha-thalassemia and is often fatal, causing life-threatening complications at birth or shortly thereafter.

2. Beta-Thalassemia:

The beta protein chains of hemoglobin are produced from two beta-globin genes, and beta-thalassemia has three main subtypes:

• Beta-Thalassemia Minor: One beta-globin gene is affected, usually causing mild symptoms or mild anemia that generally doesn’t require treatment.
• Beta-Thalassemia Intermedia: This type results from one affected beta-globin gene and causes moderate to severe anemia. Some individuals may require blood transfusions, though not as frequently as those with more severe forms.
• Beta-Thalassemia Major (Cooley’s Anemia): Both beta-globin genes are affected. This is the most severe form of beta-thalassemia, leading to severe anemia and requires regular blood transfusions and ongoing medical care.

To summarise, beta-thalassemia major and alpha-thalassemia major are the most severe forms of thalassemia. These 2 conditions often require regular medical treatment, including blood transfusions and specialized care to manage symptoms and prevent complications.

Diagnosing Thalassemia: How to Know if You Have It

Diagnosing thalassemia usually depends on checking the full blood count, a common blood test that checks levels of red blood cells and hemoglobin. If the full blood count shows signs of anemia or smaller-than-normal red blood cells, the doctor may order more specific tests.

1. Hemoglobin Electrophoresis: 

This test measures the types of hemoglobin in the blood. In people with thalassemia, hemoglobin levels will be abnormal or missing.

2. Genetic Testing: 

In some cases, especially if there is a family history of thalassemia, genetic testing can help confirm the diagnosis. Genetic tests look for mutations in the genes responsible for producing hemoglobin.

Early detection through these tests allows people to manage symptoms and prevent complications, especially in more severe types of thalassemia.

The Role of Dietitian in Managing Thalassemia

Good nutrition supports everyone’s overall health, and it’s especially vital for those managing chronic conditions like thalassemia. Medical nutrition therapy is a specialized dietary care that focuses on using food and nutrition to support people with specific health conditions. While there is no cure for thalassemia, diet can play an important role in managing symptoms and improving quality of life. 

How Diet Can Make a Difference:

1. Iron Management: Finding the Right Balance

Managing iron levels is one of the most crucial aspects of diet for people with thalassemia. Those with thalassemia are often at risk of iron overload, even if they don’t receive blood transfusions. Excess iron can harm the heart, liver, and endocrine system, so it’s generally recommended to avoid foods high in iron. Also, iron supplements should be avoided unless prescribed by a healthcare provider.

• Limit Iron-Rich Foods: 

Animal source proteins like red meat (beef, pork, lamb, mutton) and organ meats contain large amounts of heme iron which can be easily absorbed by our body. Besides that, iron-fortified cereals and certain beans (such as lentils and chickpeas) are also high in iron. 

• Avoid Iron supplements and Multivitamins with Iron:

Since Thalassemia patients are highly at risk for iron overload, it is also important that they avoid iron supplements and multivitamins containing iron. This is because these iron containing supplements can further contribute to iron overload and increase the risk of various complications. Therefore, always check food labels on multivitamins and supplements as many of them may contain iron, even if it’s not the primary ingredient. 

• Avoid Vitamin C with Iron-Rich Meals: 

Vitamin C boosts iron absorption, so try to separate vitamin C-rich foods (like oranges, strawberries, or bell peppers) from meals containing iron. However, vitamin C is still important for immune health, so be sure to eat it with non-iron-rich meals.

• Encourage consumption of Dairy products, Coffee, Tea and Soy

Dairy products, tea, coffee, and soy-based foods (such as tofu and edamame) can inhibit iron absorption, which is beneficial for those with thalassemia. Consuming black tea or soy with meals can help reduce iron absorption from food.

2. Folic Acid for Blood Health

Folic acid is essential for red blood cell production, and it’s often recommended for individuals with thalassemia to support blood health. Folic acid-rich foods can benefit the body by producing healthy red blood cells, which is especially important for people with anemia.

• Sources of Folic Acid: 

Leafy greens (like spinach and kale), beans, lentils, and citrus fruits (orange, lemon, yuzu, grapefruit) are great sources of folic acid. Consider including these foods in your meals to help boost folate levels naturally.

3. Calcium, Vitamin D and Magnesium for Bone Strength 

Calcium, vitamin D and magnesium deficiency are common among people with thalassemia. Since all these 3 nutrient contributes important role in maintaining bone strength, it was found that people with thalassemia may sometimes experience weakened bones or other skeletal issues. Therefore, ensuring adequate intake of calcium and vitamin D can help maintain bone strength.

• Calcium Rich Foods 

Dairy products (such as yoghurt, and cheese), leafy green vegetables (spinach, bak choy, and kale), and fortified plant-based milk are good sources of calcium.

• Vitamin D: 

Vitamin D can be found in fortified dairy products, fatty fish, and through sun exposure. A healthcare provider may also recommend a supplement if needed.

• Magnesium:
  Magnesium deficiency is common in individuals with thalassemia, and foods like nuts, seeds, and whole grains (oatmeal, wholemeal bread or flour, corn) can help provide this essential mineral.

4. Antioxidants for Immune Support: 

People with thalassemia may have a higher risk of infections. Antioxidants, like vitamins C and E, help support the immune system and protect cells from damage. Colourful fruits and vegetables (berries, oranges, peppers, and nuts) are rich in these nutrients and add variety to meals. Just remember, don’t consume them together with iron-rich foods!

A Balanced Approach to Health

Living with thalassemia requires ongoing care and attention, and a thoughtful diet can be a valuable part of managing the condition. While it may seem challenging at first, focusing on foods that nourish the body, avoiding excess iron, and ensuring adequate vitamins and minerals can make a real difference. Hence, if you have questions or would like personalized support, consider reaching out to a dietitian to receive a tailored plan that works for your needs. 

Book a Session with Us

Take the first step toward improving your blood’s health by booking a Diet Consultation Session (RM 399), which includes: 

• A 1-hour NFPE nutrition-focused physical examination (certified by Rutgers University on malnutrition assessment)
• Anthropometry measurements (muscle mass, fat, weight)
• A detailed diet assessment and consultation with a dietitian on personalized diet plan (certified by KKM)
• A 1-hour Muscle Strengthening Session using the Dr. Kiseki medical device (worth RM120), a KKM-certified medical device for neuromuscular health. 

Location: Klinik RE, Bukit Damansara, Kuala Lumpur
Call: 011 54308984 (Dietitian Team) to book your appointment.

Let us guide you toward a stronger, healthier you!