Abstract
The thalassemias are a group of inherited disorders of hemoglobin synthesis characterized by various degrees of defective production of the α- or β-globin chains of adult hemoglobin A. Non-transfusion- dependent thalassemia (NTDT) includes a group of thalassemia patients who do not require regular RBC transfusions for survival, but may require occasional transfusions due to infection or pregnancy or may require more regular transfusions later in life due to splenomegaly or other complications. Due to the rising phenomenon of global migration, this previously well-localized entity is currently spreading more and more worldwide reaching Northern America and Northern Europe. The clinical picture of NTDT is governed by the severity of the ineffective erythropoiesis and the chronic hemolytic anemia, which, in turn, lead to iron overload, hypercoagulability, and an array of clinical complications involving almost every organ system. Patients with NTDT suffer from complications that are distinct from those encountered in patients with transfusion- dependent thalassemia (TDT) in addition to the complications shared by both TDT and NTDT. As a consequence, patients with NTDT deserve a care specifically tailored to their needs. In the care of patients with NTDT, aiming at a standardized yet personalized care is not an easy task especially that NTDT patients lie on a heterogeneous spectrum with a wide variability in their clinical presentation and response to therapy. Therefore, guidelines emerge as a necessity to answer the specific needs of NTDT patients and the clinicians caring for them. In this article, we summarize the complications most commonly associated with NTDT and the recommendations of the guidelines for the management of patients with NTDT, based on the best available evidence.
Highlights
The thalassemias are a group of inherited disorders of hemoglobin synthesis characterized by various degrees of defective production of the α- or β-globin chains of adult hemoglobin A
Patients with Non-trans- Introduction fusion-dependent thalassemia (NTDT) suffer from complications that are distinct from those encountered in patients with transfurc sion-dependent thalassemia (TDT) in addition to the complications e shared by both TDT and NTDT
We summarize the complicaNon tions most commonly associated with NTDT and the recommenda
Summary
The thalassemias are a group of inherited disorders of hemoglobin synthesis characterized by various degrees of defective production of the α- or β-globin chains of adult hemoglobin A, leading to α- or β-thalassemia, respectively. Transfusion-dependence in these congenital anemias has been traditionally used as a tool to differentiate between the various thalassemia phenotypes and their respective severity. Nontransfusion-dependent thalassemia (NTDT) refers to a subset of thalassemia phenotypes that does not require lifelong regular transfusions for survival but may need transfusions in specific clinical settings and only for defined periods of time (pregnancy, infection, growth failure, splenomegaly-induced hemoglobin drop) (Figure 1).[1,2,3,4] Out of the numerous NTDT genotypes, the three most studied are: βthalassemia intermedia, hemoglobin E/β-thalassemia, and α-thalassemia intermedia (HbH disease) (Figure 2).[5] The clinical picture of NTDT is governed by the severity of the ineffective erythropoiesis and the chronic hemolytic anemia, which, in turn, lead to iron overload, hypercoagulability, and an array of clinical complications involving almost every organ system. NTDT remains to be a clinical diagnosis par excellence because patients tend to present at an older age and show milder symptoms compared to TDT patients
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