Despite their transfusion-independence, non-transfusion-dependent
thalassemia (NTDT) patients experience a variety of serious clinical complications that require prompt and comprehensive management. Transfusion
therapy may still be an important part of management of this disease, in cases of acute stress, to support growth and development in childhood, or to prevent clinical morbidities stemming from ineffective erythropoiesis or
hemolytic anemia. Although
splenectomy is associated with improvements in
hemoglobin levels, it leads to several short- and long-term adverse events, warranting caution in application of this intervention.
Fetal hemoglobin induction
therapy has been evaluated in non-randomized studies, with benefits extending beyond hematologic improvements to lowering morbidity risk. Effective and safe
iron chelation therapy is now available for NTDT patients in whom
iron overload develops, irrespective of transfusions, due to increased intestinal absorption, ultimately leading to clinically high
iron burden levels and subsequent morbidity. Optimal management of NTDT patients requires a holistic approach targeting all hallmarks of the disease to ensure favorable patient outcomes.