Last reviewed: 2 Sep 2023
Last updated: 30 Mar 2021



History and exam

Key diagnostic factors

  • country of origin or ancestry
  • family history
  • asymptomatic
More key diagnostic factors

Other diagnostic factors

  • lethargy
  • abdominal distension
  • failure to gain weight
  • low height and weight
  • pallor
  • spinal changes
  • large head
  • chipmunk facies
  • misaligned teeth
  • hepatosplenomegaly
  • jaundice
Other diagnostic factors

Risk factors

  • positive family history
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC
  • peripheral smear
  • reticulocyte count
  • hemoglobin analysis
  • LFTs
  • plain x-rays of skull
  • abdominal ultrasonography
  • plain x-rays of long bones
More 1st investigations to order

Investigations to consider

  • genetic testing
  • HLA typing
More investigations to consider

Treatment algorithm


beta-thalassemia trait

beta-thalassemia intermedia: non-transfusion-dependent

beta-thalassemia intermedia: transfusion-dependent

beta-thalassemia major



Sujit Sheth, MD

Professor of Clinical Pediatrics

Weill-Cornell Medical College

New York



SS is a consultant for Bristol Myers Squibb (formerly Celgene), manufacturer of luspatercept; for Bluebirdbio, developer of a gene therapy product for transfusion dependent beta-thalassemia; and for Agios, related to mitapivat for thalassemia. Steering committee member for CTX001, gene editing product by CRISPR/Vertex. Participation in multicenter trials conducted by LaJolla, Bristol Myers Squibb, Terumo, Novartis, Dispersol. SS is also an author of references cited in this topic.

Peer reviewers

Christoph Pechlaner, MD

Associate Professor of Medicine

Innsbruck Medical University




CP declares that he has no competing interests.

Michael R. Jeng, MD

Associate Professor

Pediatric Hematology & Oncology

Stanford University School of Medicine

Palo Alto



MRJ declares that he has no competing interests.

  • Differentials

    • Congenital dyserythropoietic anemia (CDA)
    • Pyruvate kinase (PK) deficiency
    • Mild iron deficiency anemia
    More Differentials
  • Guidelines

    • Guidelines for the management of non transfusion dependent thalassaemia, 2nd edition
    • Guidelines for the management of non transfusion dependent thalassaemia, 2nd edition
    More Guidelines
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