Lyanne and her sis have always fascinated me because they both stopped taking regular transfusions years ago. This brings up the gray area between intermedia and major. Intermedia is such a vague classification so maybe it applies to the sisters in some way. I think many intermedias have been transfused when they were young in order to counter slow development and failure to thrive. Their Hb levels may be closer to an intermedia range than major but if normal development is not taking place, it makes sense to transfuse. However, once grown and development has finished, patients may be able to become transfusion free, as their Hb maintains high enough to manage without taking blood. Lyanne is also taking some very important supplements and I am sure they help her produce blood and keep her energy level up. This should be an important part of all thals' health programs.
I think this is a lesson for parents of children who are on the borderline. If your child is not thriving, it makes sense to transfuse. It may not result in lifetime dependency but only during the growing years and normal development is of extreme importance because it cannot be made up later. Once the child becomes an adult, a review should be done to see if reducing or totally eliminating transfusions is a possibility. One young patient that comes to mind is Kathleen's child, Olivia. She may need to transfuse regularly or sporadically as she grows but as an adult it may be worthwhile to explore the option of reducing or eliminating transfusions altogether.