Hello Chris,
Welcome to the site. It is always good to have members wanting to learn more about their health.
I am NOT a doctor or a Thal(Major), but can answer a few of your questions, as I have a Thal(Major) niece and have gone through some of your questions
We just found out my My wife is pregnant with our second and we're going through the same hand-wringing about thal major.
I am not sure if you have heard of CVS - Chorionic Villus Sampling (CVS) which is an option and can be carried out during the 8th to 11th week of pregnancy. DNA is extracted and sent out to decide whether the foetus has thalassaemia major or not.
1) Assuming a thal major assiduously follows all therapy modes, what is a reasonable life expectancy NOW for someone with thal major?
- This is a very tough question. Each one of us wants to know the answer to this question. I have heard some Thal(Major)s are in their 50's and doing well, while I also hear that some Thals do NOT make it out of their teens. The most important thing is Compliance to treatment and that is one important factor anyone has to consider. Thalassemia leads to other complications, but if ideal management of thalassemia is done, Thal(Major)s can live a fairly normal life. Also, it depends on what type of Thal(Major) are we talking about. If it is Alpha Thal(Major), there are chances of the fetus having complications in-vitro. Are you Alpha Thal(Minor) or Beta Thal (Minor)?
2) Does ExJade substitute for IV chelation therapy and/or transfusions, or is it supplemental to them?
Good thing, you brought up this question.
Exjade is NOT a substitue of Transfusion. It is a Oral Chelation tablet, which most of us have been dreaming of to be the magical pill, but each drug has its own limitations and there are some drugs which are NOT for a particular person. I have known of few patients who had to STOP Exjade for Iron Chelation and a lot of us know Kelfer(L1) has not been the drug for them(due to its side effects). Desferal is painful(Inserting needle in the body sub cutaneous).
IV Chelation is usually recommended when the Serum Ferritin level is quite high
3) At what age does a thal major patient have to start transfusions?
This is a very good question. Christine's daughter is still NOT on transfusion while there are members whose daughter had to get a transfusion for their 2 month old. But, mostly it goes by the Hemoglobin level. The higher the Hb level, the better it is. Also, similar to the child living on the Fetal Hemoglobin in the mother's womb, the child can do well with Fetal Hb in the initial phase of their life, but the problem can start when Fetal Hb switches to Adult Hemoglobin and due to the thal mutations, it does NOT happen well. So, the Hb level starts dropping and if the Hb level goes too low, bone deformities can happen in the child. Although, I guess it depends on the doctors advise and the parents decision.
4) Assuming you are a thal minor or non-carrier parent, can you donate your own blood for the transfusions to minimize risks of tainted blood, etc.?
Again, it depends. Thal(Minor)s might be able to donate, but that is decided by the facility taking our blood. I know in USA, when I went to donate blood, they said they won't take it as I have just visited India(3 month prior to my donation attempt). Similary, they might have a check list on who can donate at a particular place. In India, I was able to donate, even when I told them I might be a Thal(Minor). They just checked the Hemoglobin level and as it was in the normal range, they took it. I guess it can also be used for platelets, wbc etc if the RBCs were low
5)Over time, do your kids adjust to the transfusions or is it always traumatic?
This question might be better answered by the parents of a Thal(Major) child or a member who has gone through it
Chris, Hope you get some idea of your questions and do ask any more questions to clear any thoughts. We will try to answer as there are many members who have different experiences