Thalassemia Patients Research Articles

Treating Thalassemia Patients with Luspatercept: An Expert Opinion Based on Current Evidence.

Luspatercept has recently been approved for the treatment of beta-thalassemia and its use in clinical practice has been increasing. As it is the first erythroid maturation drug available for this diagnosis, the expertise about its use is still limited. To address this point, and to promote awareness and guide the clinical use of luspatercept in beta-thalassemia, this paper was developed as a consensus by experts from the Italian Society of Thalassemia and Hemoglobinopathies (SITE). After a brief presentation of the core features of luspatercept, a comprehensive set of questions is addressed, covering relevant aspects for the practical management of this new therapeutic option.

Study of tuberculosis and other infections among children (age 2 to 18 years) with multitransfused thalassemia major

Background: In India, beta thalassemia is prevalent across the country, with an average frequency of carriers being 3-4%. Infection is the major cause of morbidity and mortality in thalassemia, so regular screening is required for this disease. Methods: Ethical clearance taken from institutional ethical committee. 150 thalassemia patients were enrolled in study after informed written consent. The medical histories were obtained from the patients and their files. Clinical examination was done including anthropometry, general examination, and systemic examination. MT and chest X-ray (CXR) were done for screening of tuberculosis infection. Blood samples were taken for S. ferritin, S. creatinine, serum glutamic pyruvic transaminase (SGPT), human immunodeficiency virus (HIV), and hepatitis B surface antigen (HBsAg) tests. Transfusion and other detail were taken like iron chelator, folic acid (FA) and calcium supplements. Results: In this study, out of 150 patients, 4 patients were RVD positive and 34 patients were HCV positive. No Patients found HBsAg positive. No patient had Montoux test reactive and chest X-ray positive finding. Conclusions: : Increase frequency of transfusion-related infection (hepatitis C, B, and HIV) in multi-transfused thalassemia. No correlation was found between tuberculosis infection and thalassemia patients in this screening study.

Safety and efficacy of combination of oral iron chelators in thalassemia major patients

Background: To assess the safety and efficacy of combination of oral iron chelation therapy in transfusion dependent thalassemia patients and to compare it with other regimes. Method: 150 transfusion dependent thalassemia patients with iron overload were recruited for a prospective, case control study. They were divided into 4 groups based on their chelation regime. The drugs used were deferasirox (DFX) alone, deferiprone (DFP) alone, DFP+DFX in combination, parenteral desferrioxamine (DFO) with either DFX or DFP with 50, 15, 70 and 15 in each group respectively. Doses used were DFX-30 mg/kg, DFP- 75 mg/kg/day, DFP+DFX-50 +30 mg/kg/day, DFO+DFP-25 mg/kg/d+50 mg/kg/day and DFO+DFX-25 mg/kg/d +30 mg/kg/d daily. Base line haematological, hepatic and renal profile and S. ferritin samples were collected and analyzed. Patients were monitored monthly for compliance and side effects. 30 patients were excluded during the course of study. Tests were repeated after 18 months period and the results of 120 patients were compared between the groups and statistically analyzed. Results: There was statistically significant reduction of S. ferritin in both groups taking oral combination therapy and parenteral therapy (p<0.0001). There were no serious hematological, renal/hepatic side effects in any groups. Conclusions: The oral combination therapy of iron chelators is safer and was well tolerated by all the patients and is similarly efficacious to the parenteral therapy in lowering S. ferritin.

A New Perspective for Potential Organ Damage Due to Iron-Mediated Oxidation in Thalassemia Major Patients

The aim of this study is to develop new perspectives to prevent or reduce potential organ damage due to iron-mediated oxidation in thalassemia major patients. Seventy patients were included in this study. Blood samples were taken from the patients before and after transfusion. Total thiol, native thiol, disulfide, disulfide/native thiol percentage ratio, ischemia modified albumin (IMA), total antioxidant status (TAS), total oxidant status (TOS), and ferroxidase levels were determined. Additionally, undepleted thiol level (UTL) was determined as a new parameter associated with organ damage. After transfusion, the levels of native thiol, total thiol, disulfide, TAS, ferroxidase, and TOS were higher, while the IMA levels and disulfide/native thiol percent ratio were lower. Significant correlations were found between antioxidant and oxidant tests before and after transfusion. Additionally, a negative correlation was found between the TOS and UTL levels of the patients measured before the transfusion. In the present study, transfusion therapy increased both oxidation and the antioxidant levels. In addition, the term UTL has been introduced as a parameter that enables the determination of the oxidation level that may cause potential organ damage in transfusion-dependent thalassemia patients.

Thalassemia care in Nepal: In dire need of improvement.

Thalassemia care in Nepal: In dire need of improvement.

Prevalence and risk factors of osteoporosis and osteoarthritis among Beta Thalassemia patients

Objective: This study aims to examine the clinical and radiological features of skeletal changes in patients with thalassemia and provide a comprehensive overview of osteoporosis and osteoarthritis in these patients. Materials and Methods: We conducted a retrospective analysis of patients with transfusion-dependent thalassemia, both adults and children, who received follow-up care at our thalassemia center between 2019 and 2020.. Thalassemia was diagnosed via hemoglobin electrophoresis. Transfusion-dependent patients were defined as those who received transfusions every 2-4 weeks, while the control group consisted of individuals with thalassemia trait/carriers.. Both groups were analyzed for clinical characteristics, and Dual-energy X-ray absorptiometry (DEXA) scans, and radiographic images of the knee and wrist were evaluated. Results: DEXA scans of the femur and lumbar spine showed that the prevalence of osteoporosis , Synovial hypertrophy of the wrist joint , wrist effusion , knee effusion, and Power Doppler signals on wrist ultrasound scans was statistically significantly higher in transfusion-dependent thalassemia compared to patients with thalassemia carriers. Conclusion: Beta thalassemia is an inherited multisystem disease that leads to various musculoskeletal abnormalities. Knowledge of the musculoskeletal manifestations of thalassemia allows clinicians to guide their treatment. Familiarity with the radiological features of beta thalassemia is crucial for physicians in the timely diagnosis and management of thalassemia and its complications

Molecular spectrum of α- and β-thalassemia among individuals of reproductive age in the Zhuhai region of southern China.

Thalassemia is the most common monogenic disease in South and Southeast Asia. An accurate assessment of the relative frequency and composition of thalassemia mutations is important for the design of appropriate strategies to prevent the disease. In this study, we aimed to decode the molecular characterization of thalassemia mutations in Zhuhai region of southern China. A total of 8048 individuals who were potential thalassemia carriers were enrolled. Gap-polymerase chain reaction (Gap-PCR) and reverse dot-blot (RDB) hybridization methods were employed to detect common deletional and non-deletional thalassemia mutations. Multiplex ligation dependent probe amplification (MLPA) and Sanger sequencing were used to analyze and verify rare and complex mutations. We diagnosed 3433 individuals as thalassemia carriers or patients. Of these, 2395 (69.76%) individuals with α-thalassemia harbored 13 α-globin gene mutations. The three most common α-thalassemia mutations were --SEA (60.08%), -α3.7 (20.62%) and -α4.2 (9.25%). We diagnosed 903 (26.30%) individuals with β-thalassemia and identified 20 β-globin gene mutations, of which the three most frequent were CD41/42 (-TCTT) (38.10%), IVS-II-654 (C>T) (23.69%) and TATAbox-28 (A>G) (15.18%). In addition, we identified 15 rare thalassemia variants. We also summarized the association between the thalassemia genotype and hematological parameters, which demonstrated the broad phenotypic heterogeneity caused by globin gene mutations. This is the first survey of thalassemia molecular epidemiology and hematological phenotype in Zhuhai region. It uncovered a high prevalence and complex molecular spectrum of thalassemia. These findings can be used as a basis for thalassemia diagnosis, counseling and prevention management.

Prevalence of Alloantibodies in Thalassemia Patients and Its Relationship With Age, Gender and Blood Group

To determine the prevalence of alloantibodies in patients with thalassemia and its relationship with age, sex, and blood group. A cross-sectional study was conducted on thalassemia patients requiring a blood transfusion presenting to Children’s Medical Center and Bahmari Hospital in 2021. All patients who received blood transfusions in the first year of life were included in the study, and patients with sickle cell anemia and thalassemia intermedia were excluded. Blood samples were collected, and the level of alloantibodies was measured. One hundred and ninety-five patients were evaluated in this study, of whom 100 (51.3%) were male. The mean age of the subjects was 21.37±8.57 years (range: 1-42 years). The prevalence of alloantibody positivity was 16.41% (11.17-21.65) in all subjects, 19% (11.18-26.82) in males, and 13.68% (6.65-20.72) in females (P=0.318). The mean age of alloantibody positive and negative subjects was 18.94±9.7 and 21.85±8.29 years, respectively (P=0.079). The prevalence of alloantibody positivity was 21.88% (6.73-37.02) in Rh+ and 15.34% (9.75-20.93) in Rh- patients (P=0.364). The prevalence of alloantibody positivity was 13.46% (3.87-23.06) in blood type A, 26.67% (1.32-52.02) in blood type AB, 14.29% (3.25-25.32) in blood type B, and 17.44% (9.26-25.63) in blood type O, indicating no significant difference in this regard (P=0.625). The results showed that thalassemia patients were at risk for alloantibody positivity. Age, sex, and blood type had no significant association with the prevalence of alloantibody positivity. Considering the serious complications of these antibodies, these patients should be continuously screened for the presence of alloantibodies.

A high-throughput newborn screening approach for SCID, SMA, and SCD combining multiplex qPCR and tandem mass spectrometry.

Early diagnosis of severe combined immunodeficiency (SCID), spinal muscular atrophy (SMA), and sickle cell disease (SCD) improves health outcomes by providing a specific treatment before the onset of symptoms. A high-throughput nucleic acid-based method in newborn screening (NBS) has been shown to be fast and cost-effective in the early detection of these diseases. Screening for SCD has been included in Germany's NBS Program since Fall 2021 and typically requires high-throughput NBS laboratories to adopt analytical platforms that are demanding in terms of instrumentation and personnel. Thus, we developed a combined approach applying a multiplexed quantitative real-time PCR (qPCR) assay for simultaneous SCID, SMA, and 1st-tier SCD screening, followed by a tandem mass spectrometry (MS/MS) assay for 2nd-tier SCD screening. DNA is extracted from a 3.2-mm dried blood spot from which we simultaneously quantify T-cell receptor excision circles for SCID screening, identify the homozygous SMN1 exon 7 deletion for SMA screening, and determine the integrity of the DNA extraction through the quantification of a housekeeping gene. In our two-tier SCD screening strategy, our multiplex qPCR identifies samples carrying the HBB: c.20A>T allele that is coding for sickle cell hemoglobin (HbS). Subsequently, the 2nd tier MS/MS assay is used to distinguish heterozygous HbS/A carriers from samples of patients with homozygous or compound heterozygous SCD. Between July 2021 and March 2022, 96,015 samples were screened by applying the newly implemented assay. The screening revealed two positive SCID cases, while 14 newborns with SMA were detected. Concurrently, the qPCR assay registered HbS in 431 samples which were submitted to 2nd-tier SCD screening, resulting in 17 HbS/S, five HbS/C, and two HbS/β thalassemia patients. The results of our quadruplex qPCR assay demonstrate a cost-effective and fast approach for a combined screening of three diseases that benefit from nucleic-acid based methods in high-throughput NBS laboratories.

Polyneuropathy Associated with Age of Starting the Transfusion and Serum Ferritin Level in Iranian Patients with Thalassemia Major and Intermedia

Considering the importance of managing patients with β-thalassemia and the importance of early detection of disease complications, we examined the rate of sensorimotor neuropathy in patients with β-thalassemia and the risk factors related to it. This cross-sectional study included 44 blood transfusion-dependent β-thalassemia patients aged 5 years and older. Nerve conduction studies (NCSs) were performed via standard procedures for both motor and sensory nerves. Neuropathy was observed in 14 patients (31.8%). NCS results for sensorimotor nerves in patients were within normal range. In motor NCS results, increased ulnar nerve amplitude was observed in patients with increasing age, and peroneal nerve delay in patients with an increase in serum ferritin level (p < 0.05). In sensory NCS results, delayed ulnar and sural nerves latencies were found in patients with an increase in serum ferritin level (p < 0.05). We provide data that sensorimotor neuropathy exists in thalassemia patients. It seems that with the increase of serum ferritin level and the age of patients, neuropathy becomes more obvious, while other factors such as gender, body mass index, and the number of transfusions may not be associated with neuropathy.

α- and β-Genotyping of Thalassemia Patients Based on a Multimodal Liver MRI Radiomics Model: A Preliminary Study in Two Centers

So far, there is no non-invasive method that can popularize the genetic testing of thalassemia (TM) patients on a large scale. The purpose of the study was to investigate the value of predicting the α- and β- genotypes of TM patients based on a liver MRI radiomics model. Radiomics features of liver MRI image data and clinical data of 175 TM patients were extracted using Analysis Kinetics (AK) software. The radiomics model with optimal predictive performance was combined with the clinical model to construct a joint model. The predictive performance of the model was evaluated in terms of AUC, accuracy, sensitivity, and specificity. The T2 model showed the best predictive performance: the AUC, accuracy, sensitivity, and specificity of the validation group were 0.88, 0.865, 0.875, and 0.833, respectively. The joint model constructed from T2 image features and clinical features showed higher predictive performance: the AUC, accuracy, sensitivity, and specificity of the validation group were 0.91, 0.846, 0.9, and 0.667, respectively. The liver MRI radiomics model is feasible and reliable for predicting α- and β-genotypes in TM patients.

A confirmatory study of the calibration formula between liver iron concentration (LIC) and R2* values in thalassemia patients

A confirmatory study of the calibration formula between liver iron concentration (LIC) and R2* values in thalassemia patients

A comparison of skeletal age of thalassemic patients of 9 – 15 years with chronological age by radiography.

Objective: To compare bone/skeletal age of thalassemic children with chronological age by hand-wrist radiography to assess possible growth retardation. Study Design: Descriptive Cross-sectional study. Setting: In collaboration of Radiology &amp; Pathology Department of Sahiwal Teaching Hospital and Ali Zaib Foundation, Sahiwal. Period: January 2021 to June 2021. Material &amp; Methods: Three hundred and fifty patients were purposively recruited for the study. Among them 250 were registered children of thalassemia at Ali Zaib Foundation, Sahiwal and 100 were non-thalassemic children taken as control group to make comparison of the findings from thalassemia patients. After approval from institutional review board (IRB) and taking written informed consent of the parents, the researchers get their hand-wrist radiographs done. Ossification centers were evaluated to assess bone age that was compared with chronological age. Data was analyzed using SPSS-24. Results: The statically significant difference was seen in bone age between the two groups as compared to their chronological age that remained statically non – significant. Conclusion: To evaluate possible growth retardation in thalassemia children, hand-wrist X-ray can be considered a standard modality.

Optimized serum ferritin prediction of iron overload in transfusion-dependent thalassemia: likelihood ratio and age-adjustment approach.

Early detection of iron overload in transfusion-dependent thalassemia (TDT) patients is critical to prevent complications and improve survival. Evaluate the utility of serum ferritin (SF) in the prediction of hepatic and myocardial iron overload (HIO and MIO) compared to T2*-MRI. Retrospective SETTINGS: Governmental hospitals. Patients with TDT who had T2*-MRI examinations between January 2016 to October 2019 were included. The predictive value of SF for detection of HIO and MIO was assessed by measuring area under the curve (AUC). A sample size of 123 cases was calculated to detect a correlation of 0.25 with 90% power and a two-sided type I error of 0.05. The correlation between SF and estimated hepatic iron concentration. 137 TDT patients who required regular blood transfusions. The predictive value of SF was excellent for detection of HIO (AUC=0.83-0.87) but fair for detection of MIO (AUC=0.67). The two independent predictors of MIO were age and SF. The log of (age × SF) enhanced the SF predictive value for MIO (AUC=0.78). SF values of 700 and 1250 mg/L effectively excluded mild and moderate HIO with a sensitivity of 97.8% and 94.2%, respectively (LR-=0.1). While SF values of 1640 and 2150 mg/L accurately diagnosed mild and moderate HIO with a specificity of 95.55% and 96.4%, respectively (LR+>10). A log of (age × SF) cut-off value of 4.15 effectively excluded MIO (LR-=0.1), while a value of 4.65 moderately confirmed MIO (LR+=3.2). SF is an excellent predictor of hepatic IO in TDT. Age adjustment enhanced its myocardial IO predictive accuracy. Likelihood ratio-based SF cut-off values may help clinicians in risk stratification and treatment decision-making. The laboratory data were gathered retrospectively and although the risk of selection bias for T2*-MRI examination is thought to be low, it cannot be ignored. None.

The effect of Vitamin E and N-acetyl cysteine on oxidative status and hemoglobin level in transfusion-dependent thalassemia patients: A systematic review and meta-analysis

The effect of Vitamin E and N-acetyl cysteine on oxidative status and hemoglobin level in transfusion-dependent thalassemia patients: A systematic review and meta-analysis

Quantitative Analysis of Liver Iron Deposition Based on Dual-Energy CT in Thalassemia Patients.

To explore the feasibility and accuracy of liver iron deposition based on dual-energy CT in thalassemia patients. 105 thalassemia patients were examined with dual-energy CT and MR liver scanning. Dual-energy CT was performed to measure CT values on 80kVp, 140kVp, and virtual iron content (VIC) imaging; ΔH was figured out by the difference in CT values between 80kVp and 140kVp. Using the liver iron concentration (LIC) obtained by FerriScan as a gold standard, the correlation between CT measurements and LIC was evaluated. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance for dual-energy CT in liver iron quantification and stratification. The correlation analysis between CT measurements and LIC showed that 80kVp, 140kVp, VIC, and ΔH all had a high positive correlation with LIC (P<0.001). The correlation analysis among different degree groups of VIC, ΔH, and LIC showed that the normal, moderate, and severe groups of VIC and ΔH had moderate or high positive correlations with that of LIC (P<0.01), but the mild group had no correlation (P>0.05). ROC analysis revealed that the corresponding optimal cutoff value of VIC was -2.8, 6.3,11.9 HU (corresponds to 3.2,7.0,15.0 mg/g dry weight) respectively, while the ΔH were 5.1, 8.4, 17.8HU, respectively. The area under the receiver operating characteristic curves (AUCs) for both VIC and ΔH increased with LIC thresholds. Dual-energy CT can accurately quantify and stratify liver iron deposition, contributing to predicting the status of liver iron deposition in thalassemia patients.

Incidence of Hepatitis B Due to Multiple Transfusions in Patients of β-Thalassemia Major

β-Thalassemia is one of the most prevalent childhood hemolytic disorders. Multiple blood transfusions of unscreened blood can result in infection transmission. After many transfusions, Hepatitis B infection in thalassemia patients was reported. Objective: To determine the incidence of Hepatitis B in β-thalassemia major patients, associated with multiple blood transfusion strategies. Methods: This cross-sectional study was executed in Pediatric department of DHQ teaching hospital Dera Ismail khan with the collaboration of the Regional Blood center, and comprised 360 patients, diagnosed with β-Thalassemia Major and maintained on multiple transfusions. Results: The average weight of the subjects was 43.50+18.76 Kg and their mean age was 13.10+2.1 years. The significantly high population of the patients (p&lt;0.05) was not immunized against Hepatitis B (73.88%), while only 26.66% (94/360) were immunized. The patients having less than 10, 11-20 and more than 20 transfusions per annum comprised 72 (20%), 157 (43.61%) and 131 (36.38%) patients, respectively. The affected patients had significantly altered hematological parameters (p&lt;0.05). The highest number of β-Thalassemia Major patients affected with Hepatitis B belonged to the Group having more than 25 transfusions of blood annually, with an incidence rate of 11.53. Conclusions: The greatest risk factor for Hepatitis B infection in β-thalassemia major patients is concluded to be multiple blood transfusions. It was also found that a huge population of Thalassemia patients was not immunized against HBV despite the severe risk. Therefore, health education and awareness campaigns are needed for the significance of Hepatitis B immunization and transfusion of screened blood.

Association of GDF15 levels with body mass index and endocrine status in β-thalassaemia.

GDF15 has emerged as a stress-induced hormone, acting on the brain to reduce food intake and body weight while affecting neuroendocrine function. Very high GDF15 levels are found in thalassaemia, where growth, energy balance and neuroendocrine function are impaired. We examined the relationships between GDF15 and anthropometric measures and endocrine status in β-thalassaemia. Cross sectional study. All β-thalassaemia patients attending the thalassaemia unit of Colombo North Teaching Hospital for blood transfusions. Anthropometric data, appetite scores, circulating GDF15, IGF, thyroid and reproductive hormone levels in 103 β-thalassaemia patients were obtained. GDF15 levels were markedly elevated in thalassaemia patients (24.2-fold with β-thalassaemia major compared with healthy controls). Among patients with β-thalassaemia major, the relationship between GDF15 and body mass index (BMI) was curvilinear with all individuals with GDF15 levels above 24,000 pg/mL having a BMI below 20 kg/m2 . After adjustment for BMI, age and Tanner stage, serum IGF1 concentrations correlated negatively with GDF15 in all thalassaemia patients (β = -.027, p = .02). We found a significant positive relationship between GDF15 and gonadotropin (in both sexes) and testosterone (in males). GDF15 levels were markedly elevated in patients with β-thalassaemia and its association with BMI is consistent with the known effect of GDF15 to reduce body weight. The inverse association between GDF15 with IGF1 levels may reflect a neuroendocrine impact of GDF15 or an indirect effect via impaired nutritional state. The positive association with testosterone in males and gonadotropins in both sexes, was surprising and should prompt further GDF15 studies on the hypothalamic pituitary gonadal axis.

HUBUNGAN TINGKAT KEPATUHAN KONSUMSI OBAT KELASI BESI DENGAN KADAR FERRITIN PADA PASIEN THALASSEMIA ANAK DI RSUD DR. MOEWARDI

Thalassemia is a hereditary hemolytic disease caused by mutations in the hemoglobin synthesis chain. Transfusion-dependent thalassemia patients require iron chelation therapy to prevent complications of iron overload. Adherence with regular iron chelation consumption is important for good survival, reducing morbidity and mortality in thalassemia patients. This research is an analysis of an observational study with a cross-sectional approach. This research was conducted at RSUD Dr. Moewardi. The subjects of this study were pediatric thalassemia patients who were taking deferiprone iron chelating drugs. The sample was taken using purposive sampling method, by analysing medical record data and the MMAS-8 questionnaire. Data were examined using the chi-square test with the SPSS application. Results: There were 56 subjects to be analyzed consisting of 23 males and 33 females. Based on the chi-square test, there was a significant relationship between consumption of iron chelating drugs and ferritin levels with p = 0.026. In addition, another study was conducted using the chi-square test regarding nutritional status and duration of thalassemia illness on ferritin levels. The results obtained were p value = 0.977 for the relationship between nutritional status and p value = 0.977 for the long duration of thalassemia illness. It can be concluded that both of them have no significant effect on ferritin levels. Adherence with taking iron chelating drugs has a significant relationship to ferritin levels in thalassemia patients.

Occurrence of Transfusion Transmitted Infections Among Transfusion Dependent Thalassemia Patients in A Tertiary Care Hospital in India

Background: Blood transfusion is an important treatment modality in the modern health care system; however, transfusion transmitted infections(TTI) could be fatal or life-threatening in some cases.Objective: To determine the occurrence of transfusion transmitted infections among transfusion dependent thalassemia patients and to study the socio-demographic characteristics of the recipients.Methods: This hospital-based descriptive longitudinal studywas conducted between February 2019 and June 2020, on 102 transfusion-dependentthalassaemic patients receiving blood transfusion at Bankura Sammilani Medical College &amp; Hospital, Bankura,West Bengal, India. They were tested for HIV, HBV, HCV, syphilis and malaria by ELISA (Enzyme Linked Immunosorbent Assay) Lisa Scan EM, Merilisa HBsAg, Merilisa HCV, RPR kit and Maleriscan malaria Pf/Pv.Results: Out of 102 patients, 5.90% were positive for TTI. The highest occurrence was found to be of HCV 3.90%. HBV and HIV showed similar occurrence of 0.98% and none came out positive for syphilis or malaria. The highest occurrence of TTI was found among females 66.7%. The average age of the participants was 7.97±3.27years. The average number of blood transfusion received per year was 11.95±2.71units. Majority of the participants belong to low socio- economic group family 62(60.8%). In respect to ethnicity 14.7%were tribal, while 85.3%were non-tribal population.Conclusion: The cause of high prevalence of HCV may be due to donors being asymptomatic in early stages and failure of detection due to window period of infection. More sensitive screening tests should be done for HIV, HBV, and HCV. All donors must be screened by NAT if not possible the patients must be screened for TTI regularly.Thalassemia patients being the most affected, premarital screening for thalassemia should be done.Every patient should be vaccinated with hepatitis B vaccine.International Journal of Human and Health Sciences Vol. 07 No. 02 April’23 Page: 171-175