Grains

• Iron-fortified breads and dry cereals

• Oatmeal cereal

For better iron absorption, add foods rich in vitamin C, e.g. citrus fruits, cantaloupe, brussel sprouts, broccoli, cauliflower.

Thalassaemia

This inherited condition is seen mainly (although not exclusively) in people from the Mediterranean basin, the Middle East, north and central India and South-East Asia including south China. The heterozygous form is usually asymptomatic; patients show little if any anaemia and require no treatment. The condition is relatively common in people from these areas. The homozygous form is a very severe congenital anaemia needing lifelong transfusional support, but is comparatively rare, even among the populations prone to thalassaemia. 2

The key to the diagnosis of the heterozygous thalassaemia minor is significant microcytosis quite out of proportion to the normal Hb or slight anaemia, and confirmed by finding a raised Hb A2 on Hb electrophoresis. DNA screening analysis is becoming available. The importance of recognising the condition lies in distinguishing it from iron-deficiency anaemia, for iron does not help thalassaemics and is theoretically contraindicated. Even more importantly it lies in recognising the risk that, if both parents have thalassaemia minor, they run a one in four chance of having a baby with thalassaemia major in every pregnancy, with devastating consequences for both the affected child and the whole family.

Treatment of thalassaemia major is transfusion to a high normal Hb with packed cells plus desferrioxamine.

This Hb variant is common throughout SouthEast Asia. 2 It has virtually no clinical effects in either the homozygous or heterozygous forms, but these people have microcytosis, which must be distinguished from iron deficiency; moreover, if the Hb E gene is combined with the thalassaemia gene, the child may have a lifelong anaemia almost as severe as thalassaemia major. Both genes are well established in the South-East Asian populations in Australia as well as in their own countries.

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