THALASSEMIA

also called Cooley's Anemia, Mediterranean Anemia, or Hereditary Leptocytosis, group of blood disorders characterized by a deficiency of hemoglobin, the blood protein that transports oxygen to the tissues. Thalassemia is caused by genetically determined abnormalities in the synthesis of one or more of the polypeptide chains that make up the globin part of hemoglobin. The various forms of the disorder are distinguished by different combinations of three variables: the particular polypeptide chain or chains that are affected; whether the affected chains are synthesized in sharply reduced quantities or not synthesized at all; and whether the disorder is inherited from one parent (heterozygous) or from both parents (homozygous). The five different polypeptide chains are named after the first five Greek letters: alpha, a; beta, b; gamma, g; delta, d; and epsilon, e. No thalassemic disorder is known to involve the e-chain. Involvement of the g-chain or d-chain is rare. Of the 19 variations of thalassemic inheritance, a few (such as the two heterozygous a-thalassemias) are benign and generally exhibit no clinical symptoms. Other forms exhibit mild anemia, while the most severe form (homozygous a-thalassemia 1) usually causes premature birth, either stillborn or with death following within a few hours. Thalassemia major (homozygous b-thalassemia) shows clinical characteristics a few months following birth: anemia, splenomegaly, and often enlarged liver. Infections commonly develop. At about the age of four, stunted physical growth becomes apparent. Many patients develop abnormally protruding upper jaws, prominent cheekbones, and marrow expansion in the long bones, ribs, or vertebrae, which fracture easily. With blood transfusion therapy and antibiotic therapy, many live into their 20s. Thalassemia minor (heterozygous b-thalassemia) is characterized by mild anemia, often presenting no symptoms, but occasionally complicated with slight enlargement of the spleen. It is believed that the potentially lethal thalassemia gene is retained in the population because it provides some protection from malaria in the heterozygous state. Thalassemia genes are widely distributed in the world but are found most often among people with ancestors from the Mediterranean, the Middle East, and southern Asia. Thalassemia has also been found in some northern Europeans and American Indians. Among blacks, the disease is unusually mild.