Thalassemia in Singapore: Everything you need to know
Did you know that thalassemia is passed on from parent to child, and can affect both males and females? In Singapore, roughly 3% of the population are carriers of the thalassemia gene. So this means the risk of your child being born with thalassemia is much higher if both you and your partner are carriers of the gene.
In this article by Pacific Prime Singapore, we explain what thalassemia is, the types and symptoms of thalassemia, and treatments for the disease, as well as the benefits of securing maternity and newborn insurance before planning for a child.
What is Thalassemia?
Thalassemia is a genetic blood condition, which is caused by an abnormal gene. It is the second most dangerous disease disrupting normal blood flow after anemia. It comes in two main forms: minor and major. While life with minor thalassemia can be totally normal, people suffering from the major type must undergo blood transfusions monthly to stay alive. That’s because thalassemia major affects a person’s ability to produce hemoglobin, which is a component of red blood cells that carries oxygen and nutrients to cells in the body, resulting in anemia.
Types and symptoms of thalassemia
As mentioned, thalassemia arises from a mistake in the genetic material for the hemoglobin protein structure. An impaired structure of hemoglobin causes the red blood cells to be smaller, less red, and transport less oxygen.
When defective, the red blood cells are destroyed in the bone marrow and the spleen. This, in turn, may lead to enlargement of the spleen and the onset of jaundice, and anemia. The symptoms of having major thalassemia disorder can be manifested as:
- Weakness and fatigue
- Impairment of concentration and attention
- Headaches and dizziness
- Accelerated heartbeat
- A greater tendency for infection
- Pain in the chest and shortness of breath (feeling of a lack of air)
- Skin ulcers
- Deformations of facial bones
- Bone marrow hypertrophy, which leads to bone deformation and increased predisposition to pathological fractures
Thalassemia and its forms
There are several types of thalassemia, which are distinguished based on the severity of its course, and the type of hemoglobin chains. In this article, we will focus on the type of thalassemia affecting the beta hemoglobin chain:
- Thalassemia minor is the mildest form of the disease, where only one strain of the hemoglobin chain is mutated and does not actually require specialized treatment in this situation.
- Thalassemia major is the most severe type of disease. It appears where two strains of the hemoglobin chain beta are mutated. Babies born with this type do not show any symptoms until they reach age 1 or 2. In many cases, there is a need for regular blood transfusion, which is aimed at sustaining the patient’s life.
Who’s at risk for thalassemia?
Thalassemia is a hereditary condition, hence a family history of the condition is the main risk factor for passing it to your children. Couples who are both carriers have a 25% risk of producing a child with thalassemia with each pregnancy. That’s why detection, and knowing your family medical history, is so important for all couples who are planning to have a baby.
Another risk factor is the person’s ethnic background, as this disorder is most commonly found in ethnicities hailing from Africa, Asia, and the Mediterranean.
How is thalassemia inherited?
The disease is passed to children by parents who carry the mutated thalassemia gene. If only one parent has the thalassemia minor gene, the chances of having a baby with thalassemia are as follows:
- 50% chance of having a child with thalassemia minor
- 50% chance of having a normal child
- 0% chance of having a child with thalassemia major
If both parents have Thalassemia minor, the chances of having a baby with thalassemia are as follows:
- 25% chance of having a child with thalassemia major
- 50% chance of having a child with thalassemia minor
- 25% chance of having a normal child
The chances are the same with each pregnancy, no matter how many children the couple may have.
Diagnostics and treatment of thalassemia
Recognizing this condition can be very difficult because it is easy to confuse it with anemia associated with iron deficiency. Often the first symptom leading to the diagnosis of the disease is an enlargement of the spleen. Due to diagnostic difficulties, the doctor usually commissions some tests, including:
- Red blood cell count
- X-ray of bones
- Assessment of the level of iron in the body
- Hemoglobin electrophoresis (a test to detect an abnormal form of hemoglobin)
- Biopsy or taking a bone marrow fragment for analysis
Treatment of thalassemia major involves regular transfusions of red blood cells. Thanks to this, it is possible to stop the production of defective blood cells and prevent abnormal bone growth and cardiac abnormalities.
It is worth mentioning that every time a blood transfusion occurs, the body is supplied with a large amount of iron, which an organism cannot generally fully cope with. As a consequence, iron is deposited in various tissues, damaging them. Excessive iron can be removed through chelation therapy.
Occasionally a splenectomy, or removal of the spleen, is required. This treatment reduces the number of blood cells destroyed in the spleen. As of now, the only known treatment that can actually cure a patient of thalassemia major is a bone marrow transplant, assuming a suitable donor is found, which is very rare.
Can thalassemia be prevented?
Because thalassemia is passed from parents to children, it is hard to prevent. If you are planning to have a baby, and know that someone in your family had thalassemia or anemia, then both you and your partner would have to take a DNA and blood test to find out whether any of you might be a carrier. A further meeting with a genetic counselor would also be required.
Is thalassemia screening and treatment covered by any insurance policy?
Depending on your plan, screenings and genetic counseling might be covered. When planning a family, check with your insurance provider or insurance broker if your policy will cover these costs.
Another thing to point out is how important it is to secure a maternity plan in Singapore. Any congenital condition, and thalassemia is considered one, will be covered under a comprehensive maternity plan for up to 30 days from the baby’s birth. That means if the baby is born with any birth defect, all the immediate medical care that he/she needs will be covered in full.
However, an issue can arise after the initial 30-day coverage under a maternity insurance plan for newborn expires. If a parent enrolls their baby within that time under their plan, they can get coverage for thalassemia, but since many congenital conditions will require lifelong care – like in the case of thalassemia major – benefits will be capped by a lifetime benefit value, and this benefit can get drained very quickly, eventually leaving a thalassemia sufferer basically uncovered for the condition.
If parents miss the deadline and don’t enroll their baby within 30 days from birth, inherited conditions may be deemed by insurers as pre-existing after a baby is no longer under the mother’s maternity plan. That means insurance plans rarely cover the congenital condition. If your baby, however, has inherited thalassemia minor, some insurers will be ready to cover your newborn baby.
Get professional health insurance advice
Pacific Prime Singapore’s mission is to simplify insurance and get our clients the coverage they need by providing them with multiple insurance and health guides, instant quotes, plan comparisons, and impartial advice on insurers, benefits, premium inflation, renewals, and claims support.
If you are an expat living in Singapore with a growing young family, then securing family health insurance may be the better option. Planning for another child? Be sure to speak to our advisors about newborn health insurance as well, as complications can arise without knowing and medical costs can add up quickly.
Refer to our 2019 maternity insurance guide for a better understanding of maternity insurance and its benefits.
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When she isn’t writing, you are most likely to find Elwira in search of the perfect plant-based burger or enjoying Hong Kong’s great outdoors either at the beach or from the boat - the closer to the sea, the better!
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