Dawaa Reference

chronic

Thalassaemia Major & Trait Referral

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

Thalassaemia International Federation (TIF) Guidelines 2021 · Egyptian National Drug Formulary - Blood Disorder Medications 2025 (folic acid monograph)

Verified against2 documents
  • Thalassaemia International Federation (TIF) Guidelines 2021
  • Egyptian National Drug Formulary - Blood Disorder Medications 2025 (folic acid monograph)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (8)

  • The trait is usually picked up by chance on a routine blood count
  • Carriers have at most mild anaemia symptoms and little to find on examination [anaemia]
  • Major declares itself between 6 and 24 months, as fetal haemoglobin gives way to adult
  • The infant presents with feeding problems, irritability, faltering growth, pallor, diarrhoea, repeated fevers and a swollen abdomen [abdominal distension · diarrhoea · failure to thrive · irritability · pallor]
  • Intermedia is milder by definition and does not need regular transfusion
  • Intermedia can appear in a child as young as two, with growth and developmental delay [developmental delay]
  • The mildest intermedia may not surface until adulthood, as tiredness and pallor [fatigue · pallor]
  • Long-standing red cell breakdown brings gallstones and gallbladder symptoms [gallstones · haemolysis]

Signs — what you find (5)

  • Untreated or undertreated children show stunted growth, jaundice, brown skin pigmentation and poor musculature [jaundice · stunted growth]
  • Also knock knees, a large liver and spleen, leg ulcers and masses of blood-forming tissue outside the marrow [foot deformity]
  • Marrow expansion deforms bone: a bossed forehead, an overgrown upper jaw and bent long bones
  • Intermedia can show the same marrow-expansion findings, yet make enough red cells to avoid transfusion
  • Under 2 years old with small-cell anaemia, mild jaundice and a big liver and spleen, the diagnosis is major [anaemia · jaundice]

Tests (12)

  • In major the count shows small pale cells, Hb less than 7g/dl, MCV 50 to 70 fl and MCH 12 to 20pg
  • Intermedia sits at Hb 7 to 10 g/dl, an MCV of 50 to 80 fl, and MCH between 16 and 24pg
  • In the trait the red cell count is often high, with a low MCV and MCH and only a slight RDW rise
  • A normal or barely raised RDW separates it from iron deficiency and sideroblastic anaemia, where RDW is high
  • The film shows small pale cells with target cells, teardrop cells and coarse basophilic stippling
  • In severe disease the film is bizarre, with wildly varying shapes and many nucleated red cells
  • Count and film alone cannot confirm it; confirmation needs haemoglobin electrophoresis or HPLC
  • The usual pattern is a fall in HbA with a mild rise in HbA2, and HbF variably raised
  • An HbA2 above 10% means a variant haemoglobin rather than beta-thalassaemia
  • The trait characteristically shows an HbA2 of 4-8% with HbF normal to slightly up
  • Major typically shows HbF markedly raised, from 30% to over 95%, with HbA2 normal or slightly up
  • Coexisting iron deficiency normalises the HbA2 and hides the trait, so the electrophoresis reads normal

If not this — what else fits (7)

  • Alpha thalassaemia is the main alternative small pale-cell anaemia
  • Anaemia of chronic disease, iron deficiency, sideroblastic anaemia and lead nephropathy complete the list
  • Sideroblastic anaemia is told apart by ring sideroblasts in marrow and raised red cell protoporphyrin, both absent here
  • Iron deficiency is excluded by normal iron studies: serum iron, iron-binding capacity and transferrin saturation
  • Other haemoglobin disorders need electrophoresis or HPLC to sort out
  • Major versus intermedia is decided clinically; no laboratory finding separates the two
  • A raised HbA2 also occurs with antiretroviral drugs, B12 or folate deficiency and an overactive thyroid

SourceStatPearls "Beta Thalassemia" - disease-level clinical article

Presentation findings are traced to the source above.

1

DEFERASIROX

1st line

Strength360 mg

Formoral.solid

Adult dose and duration

14 mg/kg once daily (film-coated tablet) or 20 mg/kg once daily (dispersible tablet) - long-term under haematology oversight

Paediatric dose

14-28 mg/kg/day [child max 1400 mg]

(Children >=2 years under pediatric haematologist: film-coated 14 mg/kg once daily, increased if needed to 28 mg/kg/day; dispersible 20 mg/kg once daily. The weight figures above are the film-coated range.)

Dose by weight
3kg42-84 mg/day
4kg56-112 mg/day
5kg70-140 mg/day
6kg84-168 mg/day
7kg98-196 mg/day
8kg112-224 mg/day
9kg126-252 mg/day
10kg140-280 mg/day
11kg154-308 mg/day
12kg168-336 mg/day
13kg182-364 mg/day
14kg196-392 mg/day
15kg210-420 mg/day
16kg224-448 mg/day
17kg238-476 mg/day
18kg252-504 mg/day
19kg266-532 mg/day
20kg280-560 mg/day
21kg294-588 mg/day
22kg308-616 mg/day
23kg322-644 mg/day
24kg336-672 mg/day
25kg350-700 mg/day
26kg364-728 mg/day
27kg378-756 mg/day
28kg392-784 mg/day
29kg406-812 mg/day
30kg420-840 mg/day
31kg434-868 mg/day
32kg448-896 mg/day
33kg462-924 mg/day
34kg476-952 mg/day
35kg490-980 mg/day
36kg504-1008 mg/day
37kg518-1036 mg/day
38kg532-1064 mg/day
39kg546-1092 mg/day
40kg560-1120 mg/day
41kg574-1148 mg/day
42kg588-1176 mg/day
43kg602-1204 mg/day
44kg616-1232 mg/day
45kg630-1260 mg/day
46kg644-1288 mg/day
47kg658-1316 mg/day
48kg672-1344 mg/day
49kg686-1372 mg/day
50kg700-1400 mg/day
Dose source

Thalassaemia International Federation (TIF) Guidelines 2021

Why

First-line oral iron chelator registered in Egypt for transfusional iron overload

Cautions
  • IRON OVERLOAD ALERT: Deferasirox is prescribed strictly for transfusional thalassaemia major under specialist care.
  • NEVER GIVE IRON SUPPLEMENTS: Iron overload causes fatal cardiac, hepatic, and endocrine toxicity.
  • Monitor renal function (creatinine) and serum ferritin monthly.
  • Thalassaemia trait (minor) requires reassurance and genetic counseling, NOT iron therapy unless co-existing iron deficiency proven.
Egyptian brands
Egyptian brandManufacturerIndicative price
DEFEROXINOVA 125MG 10 DISP. TABS.? strength differsDEBEIKY > INNOVA PHARMA208.75 EGP
DEFEROXINOVA 250MG 10 DISP. TABS.? strength differsDEBEIKY > INNOVA PHARMA392.50 EGP
RASIROXPINE 125MG 28 DISP. TABS.? strength differsHIKMA SPECIALIZED PHARMACEUTICALS750.00 EGP
RONISIROX 500MG 10 DISPERSIBLE TABS.? strength differsAVERROES PHARMA-EGYPT825.00 EGP
RASIROXPINE 250MG 28 DISP. TABS.? strength differsHIKMA SPECIALIZED PHARMACEUTICALS1099.00 EGP
EXJADE 125MG 28 DISP. TABS.? strength differsNOVARTIS1350.00 EGP
EXJADE 250MG 28 DISP. TABS.? strength differsNOVARTIS2550.00 EGP
EXJADE 500MG 28 DISP. TABS.? strength differsNOVARTIS4950.00 EGP
ANDORASIROX 500MG 20TABS. FOR ORAL SUSP.? strength differs? different route - not oral solidANDALOUS PHARMA1530.00 EGP (76.50/unit)
2

FOLIC ACID

add-on - not a substitute

Strength5 mg

Formoral.solid

Adult dose and duration

5 mg once daily - long-term

Paediatric dose

Children: 2.5-5 mg once daily

Dose source

Egyptian National Drug Formulary - Blood Disorder Medications 2025 (folic acid monograph)

Why

Adjunct vitamin supplement added to the referral pathway for thalassaemia major to meet the increased folate demand from chronic ineffective erythropoiesis; supports red cell production but does not replace transfusion therapy or specialist management.

Cautions
  • Supports ineffective erythropoiesis.
  • Do not combine with iron supplements.
Egyptian brands
Egyptian brandManufacturerIndicative price
FOLIC ACID (EL NILE) 5 MG 50 TAB.EL NILE.26.25 EGP (0.53/unit)
FOLIC ACID (MEMPHIS) 5 MG 30 TAB.MEMPHIS15.75 EGP (0.53/unit)
FOLICINAD 5 MG 50 TABS.INAD PHARMA50.00 EGP (1.00/unit)
FOLIC ACID (EIPICO) 5 MG 20 TAB.EIPICO24.00 EGP (1.20/unit)
FOLIC ACID (EL NILE) 5 MG 30 TAB.EL NILE.36.00 EGP (1.20/unit)
FOLIRAQ 5000 MCG 30 CAPSULESHP PHARMA45.00 EGP (1.50/unit)
FOLIDDOX 400 MCG / 5 ML LIQUID 150 ML? strength differs? different route - not oral solidMADDOX PHARMA150.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.