Venous and Arterial Thromboembolism
Thromboembolic events are among the most serious complications in thalassemia, and are more common among patients with non-TDT compared with TDT. In addition, patients with thalassemia may present with severe headache, therefore, a physical examination should include assessing for signs of elevated intracranial pressure, such as papilledema, nausea, vomiting, and altered mental status. Prompt initiation of anticoagulation therapy for venous sinus thrombosis is essential to prevent serious neurologic complications
In the setting of trauma, routine resuscitation procedures should be followed. Whenever possible, clinicians should ensure that the Hb is not lower than the steady state in the hemodynamically stable patient. Clinical judgment should be exercised to weigh the urgency of transfusion in the setting of trauma.
To read the detailed recommendations containing qualifying statements, readers should refer to the publication in Annals of Hematology. Additional guidance was provided on symptom-focused management, including recommendations for dyspnea, chest pain, abdominal pain, and back pain.
Addressing Disparities in Other Countries
In an email interview, lead author, Dr Saliba, noted that “There are significant disparities in the emergency care provided for patients with thalassemia in countries with higher vs lower income. Thalassemia is more prevalent in countries with low to middle income, such as the Middle East, North Africa, East Asia and Southeast Asia.”
“Providers in countries where thalassemia is less prevalent are often less familiar with the disease and its complications. As a consequence, although the tools to diagnose and treat may be readily available, [clinical practitioners] may not be acquainted with the complications and manifestations of the disease,” he explained.
“Specialized institutions focused on the chronic care of patients with thalassemia [may] help focus national efforts and streamline resources. This results in better chronic care for patients with thalassemia, fewer ED visits, and higher awareness of the disease,” Dr Saliba concluded.
1. Saliba AN, Atoui A, Labban M, et al. Thalassemia in the emergency department: special considerations for a rare disease. Ann Hematol. Published online July 3, 2020. doi: 10.1007/s00277-020-04164-6
2. Hodroj MH, Bou-Fakhredin R, Nour-Eldine W, Noureldine HA, Noureldine MHA, Taher AT. Thalassemia and malignancy: An emerging concern?. Blood Rev. 2019;37:100585. doi: 10.1016/j.blre.2019.06.002