Beta-Thalassemia & Epo

from the Journal of Athletic Training
Volume 37 • Number 2 (Supplement) • June 2002

A 22-Year Old Division I Male Football
Player Diagnosed With Beta-Thalassemia
Minor Blood Disorder: A Case Study
O’Brien MS, Ransone JW, Smith KB:
College of Education, Oklahoma State
University, Stillwater, OK
Personal data
A 22-year-old division one collegiate football
player with no remarkable medical history complains
of fatigue and inability to recover from bouts
of exercise.
Physical signs and symptoms
The athlete presented symptoms of cardiovascular
(CV) deficiency (shortness of breath, irregular
CV endurance) for which, the team physician ordered
a blood work up including baseline levels of
comprehensive metabolic profile (CMP) and complete
blood count (CBC).
Differential diagnosis
Differential diagnosis of signs and symptoms include
iron deficiency anemia, sickle cell anemia,
beta thalassemia minor, hereditary leptocytosis,
minor heterozygous beta thalassemia intermedius
Results of diagnostic imaging/laboratory tests
After a baseline CMP and CBC were completed
revealing depressed levels of hemoglobin, further
tests were ordered by the team physician. Results
of these tests coincided with hypochromic
microcytic anemia. A sickle-dex was conducted
and was found to be positive. Results of the
hemoglobin electrophoresis conducted thereafter
indicated a depressed amount of hemoglobin A
(90%, reference 93.5%- 98.3%) revealing the betathalassemia
minor disorder. Additionally, initial
blood work presented low levels of blood erythropoietin
levels (4.7 mu/mL, reference 7.3- 27.7),
hemoglobin (11.8 g/dL, reference 14.0-18.0 g/dL),
and hematocrit (37.4%, reference 42.0- 52.0%).
Blood work conducted one week post Procrit®
injections exhibited elevated hemoglobin (16.1 g/
dL) and hematocrit (48.7%). Follow up measures
obtained one month post injections revealed
a marked decrease in blood erythropoietin levels
(3.8 mu/mL) and normal levels of hemoglobin
(14.9 g/dL), and hematocrit (45.6%)
Clinical course
To treat the beta thalassemia minor anemia, the
team physician prescribed the administration of
10,000 units of Procrit® (erythropoietin supplement)
according to the athletes body weight, three
times per week for one month to restore normal
levels of hemoglobin production, 325 mg of
Ferosul® (ferrous sulfate) and 500 mg of ascorbic
acid daily.
Deviation from expected
Thalassemia minor is a blood anemia characterized
by a genetic anomaly that affects the number of
hemoglobin proteins of a single red blood cell and
their ability to carry oxygen. Thalassemia minor
is not typically seen in the athletic population
and treatment for the disorder has not been
thoroughly addressed. In this particular case, the
prescription of Procrit erythropoietin was decided
upon to elevate hemoglobin levels and re- establish
the athlete’s oxygen carrying capacity to that of
normal levels required for athletic competition.
The athlete responded well to this treatment and
continued full participation in football activity.