Bone age and thalassemia

Being somewhat anemic over time can cause bone age to be slower than chronological age.  This can cause a child to lag behind peers in height and physical development while cognitive development occurs at normal levels.  This can happen with thalassemia minor as well.  While this can be emotionally devastating to children, especially in the teen years when childrens' peers are making strides in height and muscle mass thalassemia childrem may remain smaller in stature and slimmer during the teen year.  The good news is that if well chelaated (keeping iron out of the pituitary and other hormone producing glands), and with poroper nutrition and supplementation (calcium, magnesium, zinc etc) these children will achieve their genetic height - albiet a few years later.  The good news is that this effect can continue - so that thal patients will often look much younger than their chronological age - thal minors and majors may appreciate this if they look a few years younger than their actual age because of the delayed bone age.  This effect was once achieved in ancient societies through blood letting - women in efforts to stay young would bleed themselves (a good reason to be blood donors!!) to keep looking young.  

This effect is different from iron overload in the pituitary that prevents thal majors from maturing.  Maturity is reached in cases of slow bone age in well chelated patients - it just happens later.  This may be helpful to worried parents and something parents can explain to their children during those awkward years.  We learned this from Dr. Vichinsky during our last visit.  

Sharmin

Thanks Sharmin, this is what new parents like me should know. I'm also wondering what make these thalas kid look smaller than their friends at their age. Now i knw... keep sharing!

Love- Joyce

Nice article. Are there chances for it to be after 16 or 17 as well? Because in my find, I never found anyone above 16 or 17 who achieved that state of growth.

Thanks.

PS, joyce, your baby looks cute. Blessings from my side. My god bestow showers of love over him.

First of all its great reading again ....

I have been a little concerned with Little Z's height,she hasn't gained much over past year,she is taking her supplements and taking Asunra as well,her ferritin is not somewhat ideal but its not that bad either,why isn't she gaining height i hope its just a temporary pause and she will achieve at least my height which is not much but her parents being no that tall i am not expecting more then that .

Thanks Sharmin for the info 

Zaini.

Zaini,

Well chelated thals will usually reach their genetic height (especially because well chelated thals do not have iron overload in their pituitary and other glands).  Also, ensuring that the children are getting essential nutrients and minerals is helpful.  Having her transfused before she drops below 10 will also be helpful. 

It will be useful if you were to have a bone age test on Lil Z, likely it will show that her bone age is a few years behind her chronological age - which is good news because it means that she has room to grow and that she will continue to grow once her peers stop growing. 

Little A was age 13 last summer but his bone age was between 9 and 11.  Which meant that he was 2 to 4 years behind his peers in physical growth and development.  We were therefore told to look at the growth curve for a child who was 10 years old, rather than 13 to determine what his adult height will be. 

We have been careful with adequate nutrition and keeping his hemoglobin this year to enhance his bone age, but he continues to grow at his rate.  We will see what the bone age test reveals this summer.  We will also speak with an endocrinologist about this.  His slower growth is not due to endocrine function but due to the lower hemoglobin levels.

I will keep you posted, I am sure that Lil Z is growing a little slower for the same reason. 

Sharmin

Sharmin,

Thanks for your input  i'll check if that test is available here,is their any other name for it or its called bone age test?

Zaini,

A bone age test is simply an x ray of the wrist which will identify what stage (age) of growth her bones are at. 

I am guessing that due to anemia she is likely to be a few years behind.

Sharmin

This is exactly what happened to me. I was always the smallest in my class. It wasn't until 9th grade that I grew very tall a caught up with my classmates. By graduation I was the 2nd tallest in my class. I grew even more my 1st year in college.

Thanks for sharing that Bobby, my son is convinced that he's never going to grow.  I keep telling him it'll happen soon:)

Hi Sharmin,

Thanks for throwing light. I got my bone age report done on 26th January, 2009. At that time I was 14 & half years old. In that report, my bone age was above 12 years and below 16. Does that mean mine would take effect around some period around 19-20 or somewhere after when the age of 18? I am 17 currently. It would be good if you can explain to me in a bit detail.

And, yes, whats little A's current ferritin level?

-Pratik.

Pratik,

Yes, it is a good thing that your bone age is behind it means that you have room to grow - however your iron levels, particularly the amount of iron in your pituitary and perhaps the size of your pituitary may effect whether or not you will reach your genetic height potential.  It is very important to prevent iron accumulation, and possibly reverse iron load in the pituitary in order to reach optimal growth. 

Little A's iron levels have been maintained below 1000 most of his life and during the last few years his iron level has been below 400.  The best thing you can do for yourself is to aggressively chelate iron and to maintain good hemoglobin levels.  If you can remove as much iron from your organs as possible you will maximize your chances of reaching a good height.  Seeing that you're bone age is behind your chronological age you have time to grow.  Exjade/desferal combination removes iron very quickly and efficiently but this must be monitored carefully under the care of a physician with tests every 3 weeks. 

Also, keep taking your vitamins and supplements.  There are various endocrine tests that you should take as well, doctors may prescribe hormone replacement if it is needed. 

Best,

Sharmin

Hi Sharmin,

Thanks for notifying. I was prescribed hormonal supplements (via subcutaneous injections) back in July-August 2009 and I DID took them for about 4 months, but they did not helped, maybe because of my sugar levels I don't know, at the same time rise in my sugar levels was also noticed.

I am thinking to go back to endocrinologist and consult them whether I should start over again or not.

Also I am now planning to chelate iron aggressively. I have switched to 1600 mg yesterday from 1200, just asked mom, dad is out of city and hes coming tomorrow, so lets see what he says if I should take 1600 or 1200, I would try to convince him that without 1600, I cannot assume reduction of overload quickly.

Since years, my iron moves around 5000-6500 only, and never goes down and kinda got fedup, so now I want to start over fighting vigorously over it, by hook or by crook.

-Pratik.

FYI
my height was increased in year 24 by approx 3 to 4 cms

That's great Dharmesh, you're height increased at age of 24? Impressive. Whats your current height?

That's great Dharmesh, you're height increased at age of 24? Impressive. Whats your current height?

Hi Pratik,
it is 159 cms
wht's your?