Table of ContentsView AllTable of ContentsWhat Is Thalassemia?Risk FactorsComplicationsTreatmentsFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
What Is Thalassemia?
Risk Factors
Complications
Treatments
Frequently Asked Questions
Thalassemiais a hereditary disorder that affects the production ofhemoglobin. Hemoglobin is the component of red blood cells that carries oxygen to the tissues of the body. There are many types of thalassemia. Symptoms can range from none at all to severeanemiathat requires frequent blood transfusions.
At this time, scientists are just beginning to learn how a diagnosis of thalassemia may affect the risk of COVID-19, potential complications, and how the pandemic may affect treatment, but preliminary research has revealed some trends.
Learn what having thalassemia may mean for you during the COVID-19 pandemic.
Verywell / Laura Porter
Thalassemia is an inherited disorder that impairs the production ofhemoglobin. Hemoglobin normally is made of four chains—two alpha chains and two beta chains. In thalassemia, the body is unable to make either alpha or beta chains in adequate amounts. This means red blood cells aren’t made properly or they are destroyed.
There are four types ofalpha thalassemia, and two main types of beta thalassemia. Within each of these types, the severity varies, from causing moderate to severe anemia to requiring frequent blood transfusions.
Thalassemia and COVID-19 Risk
When looking into thalassemia and COVID-19 risk, it’s important to identify both the risk of potential exposure and susceptibility.
There are a number of factors that might increase the chances of a person with thalassemia being exposed to SARS-CoV-2, the virus causing COVID-19. The need for frequent blood transfusions and complications of the disease that result in more clinic visits and hospitalizations could raise the odds that someone would come into contact with the virus.
While the research is early and there is much left to be learned, people who have thalassemia (at least some types) may be more susceptible to contracting coronavirus and having a serious outcome.
In a large Iranian study published in 2020, the prevalence of COVID-19 in people with non-transfusion dependent thalassemia (those with the disease not dependent on transfusions) was much higher than in the general population (45 vs. 22.3 infections per 10,000 people). The prevalence among those who were transfusion dependent was roughly the same as people without thalassemia.
However, some limited evidence suggests that certain types of thalassemia may have some protective effect against COVID-19. Globally, the prevalence of COVID-19 in people with beta-thalassemia specifically appears to be lower than the general population.
Risk of Severe Outcomes From COVID-19 for People With Thalassemia
Some of these complications include:
Thus far, studies have been mixed as to whether thalassemia patients are more likely to experience serious outcomes of COVID-19 (such as hospitalization or death).
The study from Iran found that having a diagnosis of thalassemia was associated with poorer outcomes, particularly for people who have complications of thalassemia.
A 2023 study suggests that people with beta-TM showed a higher incidence of SARS-CoV-2 infection than the general population (61.9% vs. 7.1%) but had a less severe clinical course.They also found that people with beta-thalassemia had better antibody responses to the vaccine and infection.
Looking at a small sample group early on in the pandemic, the overall mortality rate of those with thalassemia from a COVID-19 infection was 18.6%, compared with a mortality rate of 4.71% in the general population. (Note: The overall mortality rate for COVID-19 is currently less than 1%.).
It’s important to note that complications of thalassemia likely played a role in the severity of outcomes. Among people aged 36 or older, an average of 60% of thalassemia patients had at least one coexisting condition (100% in the non-transfusion dependent group and 41.7% in the transfusion-dependent group).
Examples of coexisting conditions included insulin-dependent diabetes, heart disease, pulmonary hypertension, kidney disease, osteoporosis, hepatitis C, liver disease, and asthma.
Complications of Thalassemia and COVID-19
People with thalassemia often experience similar COVID-19 complications as those without thalassemia, but they may be at greater risk for certain problems. Some of these include:
Pneumonia and Respiratory Failure
Secondary infections (bacterial infections that develop in people with a viral infection such as COVID-19) may be more common in people with thalassemia, especially those who have had their spleen removed. It’s recommended that antibiotics be started immediately if people develop a fever or other signs of an infection.
Respiratory failure may occur just as with people who do not have thalassemia. Common COVID-19 treatments, including prone positioning (turning a patient on their stomach), non-invasive ventilation (oxygen delivered via a face mask), and intubation and mechanical ventilation (where a tube is inserted down the throat and a machine pumps air in and out of the lungs), may be needed depending on the severity.
Blood Clots
Blood clots are fairly common with COVID-19, and many physicians view it as a disease of blood vessels. Thalassemia also increases the likelihood to form blood clots.
It’s not known whether blood clots with COVID-19 are more common among people with thalassemia, but healthcare providers should be aware of this potential risk. It’s currently recommended that people with thalassemia who have severe COVID-19 be given blood thinners, though this could change as more is learned.
Heart-Related Complications
Some people with thalassemia have cardiomyopathy (heart muscle disease). This complication should be monitored and treated as it is for people with other forms of preexisting heart disease.
Long-Term Complications
“Long COVID” is a term meaning symptoms that persist after the infection has cleared. Among people with thalassemia, little is known about long-term complications from COVID-19 at this time.
RecapPeople with thalassemia tend to experience similar complications from COVID-19 as those without thalassemia. However, certain issues, such as pneumonia and respiratory failure, blood clots, and heart-related complications, should be monitored for.
Recap
People with thalassemia tend to experience similar complications from COVID-19 as those without thalassemia. However, certain issues, such as pneumonia and respiratory failure, blood clots, and heart-related complications, should be monitored for.
Thalassemia Treatments and COVID-19
The COVID-19 pandemic may affect both the treatment of thalassemia in general and how COVID-19 is treated in people with thalassemia who become infected.
There are very few medications that are contraindicated (should not be used) in people who may be exposed to SARS-CoV-2 or who have developed a COVID-19 infection. In fact, some medications used for thalassemia may actually be helpful.
Virtual Doctor’s VisitsWhile blood transfusions and iron chelation therapy (iron-binding drugs that are sometimes given via infusion) require traveling to a clinic or hospital, there are many healthcare visits that can be handled virtually.Telehealth visits, which are appointments with a healthcare provider using electronic devices from your home, are considered the equivalent of an in-person visit in many ways and can provide excellent care in many situations. In fact, some people prefer being able to communicate with their healthcare providers from the comfort of their own home.
Virtual Doctor’s Visits
While blood transfusions and iron chelation therapy (iron-binding drugs that are sometimes given via infusion) require traveling to a clinic or hospital, there are many healthcare visits that can be handled virtually.Telehealth visits, which are appointments with a healthcare provider using electronic devices from your home, are considered the equivalent of an in-person visit in many ways and can provide excellent care in many situations. In fact, some people prefer being able to communicate with their healthcare providers from the comfort of their own home.
While blood transfusions and iron chelation therapy (iron-binding drugs that are sometimes given via infusion) require traveling to a clinic or hospital, there are many healthcare visits that can be handled virtually.
Telehealth visits, which are appointments with a healthcare provider using electronic devices from your home, are considered the equivalent of an in-person visit in many ways and can provide excellent care in many situations. In fact, some people prefer being able to communicate with their healthcare providers from the comfort of their own home.
Managing Anemia
Blood transfusionsare a mainstay of treatment for some people with thalassemia. Current recommendations are that a person’s usual regimen of transfusions should be continued during the pandemic.
That said, the shortage of the blood supply has proven challenging. Some blood donation programs were stopped (or decreased) worldwide, and hesitancy of blood donors to venture out and risk exposure to COVID-19 has also contributed to shortages.
This shortage has been of even greater concern in South Asia (due to a high incidence of beta-thalassemia), where it’s been estimated that 200,000 people depend on regular blood transfusions to manage their condition.
Reducing the Need for Transfusions
Sadly, the reduction in the blood supply has led many people with thalassemia to receive fewer transfusions than usual, prompting healthcare providers caring for people with the condition to look for options that may reduce the need for or frequency of transfusions. A few options include:
Current recommendations are that for people who have been treated with Reblozyl, the medication should be continued even if a person develops COVID-19 (there is no evidence that it should be stopped). For those who have not yet started the medication, delaying the use of the medication should be considered.
Monitoring Anemia with COVID-19
It’s been found that, in general, people who have COVID-19 often have significantly reduced hemoglobin levels, especially with severe disease. Since hemoglobin levels already run low for many people with thalassemia, the combination of factors has raised some concerns.
While there are no specific guidelines at this time, some researchers believe that hemoglobin levels should be monitored closely in people with thalassemia if they develop COVID-19, even when symptoms are only mild.
Managing Iron Overload
Iron overload due to repeated transfusions is the cause of many complications seen with thalassemia, and therefore many people are treated withiron chelation therapy. These medications bind to iron so that it can be expelled from the body.
These drugs can reduce inflammation in blood vessels (endothelial inflammation) during viral infections. They also may have antiviral effects and positive effects on the immune system, particularly with RNA viruses (viruses that have RNA as its genetic material, such as the virus causing COVID-19).
It’s not known whether this therapy has any effect on the outcomes of COVID-19 in people with thalassemia. But some researchers believe it may, based on the primarily mild symptoms of COVID-19 in people with thalassemia found in a study out of Southeast Asia.
Current recommendations for those in the United States is that iron chelation therapy be continued unless symptoms of COVID-19 develop. In that event, it’s advisable that the therapy be stopped until the infection has cleared.
People Who Have Had a Splenectomy and Transplant Recipients
Special consideration is needed for both people who have had their spleens removed and for those who have had bone marrow/stem cell transplants to treat their thalassemia.
People who have had splenectomies have a greater risk of developing bacterial infections as well as sepsis. For those who develop COVID-19, doctors should be aware of this increased risk of a secondary bacterial infection so that antibiotics can be started early with any signs, such as a fever.
Other Considerations
The use of corticosteroid medications (such as prednisone) can have both positive and negative effects and must be carefully weighed in people with thalassemia. On one side of the equation, glucocorticoids can slow the clearance of the virus from the respiratory tract. On the other, people with thalassemia may be at risk of adrenal insufficiency (adrenal crisis), which can worsen a person’s condition with severe COVID-19.
RecapThe COVID-19 pandemic has led to blood bank shortages, which have created challenges for people with transfusion-dependent thalassemia. Certain medications have been approved to reduce the frequency of transfusions needed.Iron chelation therapy is also a vital treatment for people with transfusion-dependent thalassemia and should be continued until COVID-19 symptoms develop.
The COVID-19 pandemic has led to blood bank shortages, which have created challenges for people with transfusion-dependent thalassemia. Certain medications have been approved to reduce the frequency of transfusions needed.Iron chelation therapy is also a vital treatment for people with transfusion-dependent thalassemia and should be continued until COVID-19 symptoms develop.
The COVID-19 pandemic has led to blood bank shortages, which have created challenges for people with transfusion-dependent thalassemia. Certain medications have been approved to reduce the frequency of transfusions needed.
Iron chelation therapy is also a vital treatment for people with transfusion-dependent thalassemia and should be continued until COVID-19 symptoms develop.
Summary
Thalassemia may increase the risk of serious outcomes of COVID-19. Additionally, COVID-19 has complicated some treatments for thalassemia, such as the availability of lifesaving blood transfusions. Working with your healthcare team to keep up with thalassemia treatments, getting vaccinated, and monitoring and treating for complications early if COVID-19 symptoms do develop are the recommended strategies to staying healthy through the pandemic.
A Word From Verywell
If you’re living with thalassemia, you may be at greater risk for serious outcomes of COVID-19. Prevention measures are very important. The most important thing you can do is make sure you are vaccinated and stay up to date on when boosters are needed.
If you become infected, it’s important to talk to a doctor knowledgeable about thalassemia regarding any special precautions you should take or changes to your medical plan.
The pandemic has been hard on everyone, especially those with chronic illnesses. Yet, no matter how difficult the trial, there are often positive points. Try taking a few moments to list a few of the positive areas in your life. To begin, think of something you’ve had time to do that you’d otherwise not have time for, or something you learned. It’s hard to focus on positives at this time, but sometimes making an effort can help you find a sense of gratitude that would otherwise be elusive.
Vitamin and mineral supplementation may be recommended for some people with thalassemia during the COVID-19 pandemic. In particular, vitamin C, vitamin E, vitamin D, zinc, and selenium. may help support the immune system’s ability to fight infections. The dosages and timing, however, should be carefully discussed with your healthcare before starting any supplement.
There is some limited evidence that certain types of thalassemia may offer some protection against SARS-CoV-2. One small study found that people with the thalassemia trait (carriers) were less likely to develop a COVID-19 infection or die from the disease.At the current time, this is primarily an academic theory.People with thalassemia should assume that they are as likely to become infected as the general population and are more likely to have severe outcomes.
There is some limited evidence that certain types of thalassemia may offer some protection against SARS-CoV-2. One small study found that people with the thalassemia trait (carriers) were less likely to develop a COVID-19 infection or die from the disease.
At the current time, this is primarily an academic theory.People with thalassemia should assume that they are as likely to become infected as the general population and are more likely to have severe outcomes.
Yes. The Centers for Disease Control and Prevention (CDC) and the Thalassemia International Federation urge people with thalassemia to get the COVID-19 vaccine. This is the most important step in keeping you out of the hospital and alive.
The information in this article is current as of the date listed. As new research becomes available, we’ll update this article. For the latest on COVID-19, visit ourcoronavirus news page.
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