Thalassemia : Challenges In Covid 19 Pandemic

Dr Sanjeev Kumar Digra
On the occasion of world thalassemia day thought goes to trial tribulations of a person with thalassemia, if those were not enough the current Pandemic has compounded the problems of thalssemics.
Thalassemia is an inherited disorder of red blood cells characterized by defective synthesis of hemoglobin leading in rapid destruction of RBCs resulting into chronic anemia making these individuals dependent on regular blood transfusions. Chronic hemolysis and regular blood transfusions result in iron accumulation which needs iron chelation therapy to remove excess iron from their body .
People with thalassemia face certain challenges during current Covid 19 pandemic. Every year 8th of may is observed as world thalassemia day making it an appropriate time to discuss these challenges . Covid -19 infection can cause nasopharyngeal symptoms to full blown pneumonia. Common symptoms seen in covid 19 patients are fever, cough, sore throat, body aches, diarrhea, pain abdomen and vomiting. Majority of the persons with covid-19 infection remain asymptomatic or have only mild disease however few especially with comorbidities such as long standing heart, lungs , kidney, liver , endocrinal diseases or cancers are more prone to get severe covid disease. As per the data available till date prevalence of Covid -19 is almost same in Thalassemic patients as in general population and among thalassemics morbidity and mortality is high only in those who have associated comorbidities like diabetes, pulmonary hypertension, heart disease and high iron over load.
Thalssemia International Federation (TIF) has categorized high risk thalassemia on the basis of age and comorbidity. An individual with thalassemia with any one of the following can be considered as high to highest risk:
* People over 50 years of age
* Transfusion dependent
* Non transfused with hemoglobin chronically below 7 gms% for the past 2 to 3 years
* People receiving iron chelation therapy
* Splenectomised persons or persons with asplenia
* Persons with comorbidities like diabetes, pulmonary hypertension, endocrine, cardiac or respiratory diseases.
In the prevailing circumstances various challenges being faced by people with thalassemia include prevention of covid-19 as they have to visit hospital frequently, taking care of their immunity and getting safe and adequate blood supply.
Prevention of Covid-19:
Preventive measures are same as for general population i.e.
* Wearing face mask appropriately covering nose and mouth
* six feet of social distancing as much as possible
* Washing hands frequently especially after touching any surface or your face or nose.
* Avoid touching face
* Avoid large gatherings and indoor crowded spaces
* Staying home
* If sick , isolate yourself, contact your doctor and get yourself tested for COVID-19.
As we can not completely eliminate our risk of getting covid 19 infection we can atleast try to eat healthy so as to strengthen our immunity . A position statement on COVID-19 and thalassemia has been issued by Thalassemia International Federation which include suggestions regarding strengthening of immune system. It includes recommendations on nutrition for individuals with thalassemia encouraging them to drink plenty of fluids such as water, warm soups, green tea or fresh juices and eat natural sources of vitamins, minerals and antioxidants that boost the immune system such as citrus fruits for vitamin C, dairy products for vitamin D, legumes, seeds (flaxseed, chia seeds) and nuts for zinc and omega-3 fatty acids.
Blood safety & supply :
Till now there is no evidence that covid-19 can be transmitted through blood transfusions. In fact previous corona viruses have also not shown any such ability. Pandemic has resulted in acute shortage of blood. Suspension of all elective surgeries in government and private hospitals will help in conserving the blood for emergencies and blood transfusion dependent patients like thalassemia. People should be encouraged to donate blood and Blood banks should be made as safe as possible for volunteer donors. Patients can consider establishing a pool of donors (family members or friends) who have blood type that is compatible with the recipient. However it would be better if they encourage their family members and friends to donate blood in general pool. Patients planning for bone marrow transplantation should avoid blood from family members.
Thalassemia patients should take covid-19 vaccine as per the current guidelines for general population . There are no special recommendations for thalassemics.
Despite of taking all preventive measures if a person with thalassemia still gets covid suggestive symptoms the first thing he or she should do is to isolate to prevent spread of infection . He or she should contact their treating physician and get tested for covid 19. If the test turns out to be positive, stay isolated, take good nutritious diet , take treatment as advised by the treating physician and remember to stop iron chelation drugs. Keep on monitoring temperature and oxygen saturation and be watch full for danger signs which include high grade fever (>102 F) persisting for more than 4-5 days, fast breathing, poor oral intake, irritability, lethargy, cyanosis or oxygen saturation < 94%. In case of any of these danger signs patient should be immediately hospitalized.
In nut shell thalassemia patients are not more vulnerable to covid-19 infection as compared to general population. Only those people with thalassemia who have associated long standing kidney, liver, heart , lung or endocrinal disease such as diabetes are prone to get serious disease or poor outcome. Adherence to covid specific good hygienic practices, nutritious healthy diet and healthy life style helps in strengthening the immune system providing protection against covid-19 infection.
(The author is Professor “Coordinator Thalassemia Day Care Center “Pediatrics“ SMGS Hospital “Government Medical College Jammu)