The Importance of Maintaining High Pre-Transfusion Hemoglobin Level in Thalassemia Major Patients

Thalassemia patients who do not receive adequate transfusion are at risk of splenomegaly and growth impairment. This study was conducted to evaluate the relation between pre-transfusion hemoglobin (Hb) level with spleen size and body height, also the relation between spleen size and the risk of neutropenia and thrombocytopenia. This was a retrospective study involving 171 non-splenectomized children with thalassemia major. The study was conducted in Dr Cipto Mangunkusumo National Hospital, Jakarta and used data from the past year (2017-2018). Mean pre-transfusion Hb level, neutrophil and thrombocyte count was measured for one year. Mean pre-transfusion Hb level was divided into high (Hb ≥9 g/dL) and low (Hb <9 g/dL). The results showed significant difference of spleen size between subject with high and low pre-transfusion Hb level, but not for the prevalence of stunted. Moderate to massive splenomegaly (spleen size greater than Schuffner 2) increases risk of thrombocytopenia (OR 9.40, p<0.0001), but not for neutropenia (p=0.477). Therefore, it is concluded that maintaining high pre-transfusion Hb level ≥9 g/dL brings many benefits because it prevents the occurrence of complications in children with thalassemia major.