Which statement best describes thalassemia intermedia?

• A. More mild anemia with no transfusion need
• B. Ineffective erythropoiesis, more severe anemia, often require frequent transfusions, at risk of iron overload
• C. Acute hemolysis with reticulocytosis
• D. Normal hematologic indices

Answer: (B)

Thalassemia intermedia is a phenotype where reduced but not absent globin synthesis leads to significant anemia driven by ineffective erythropoiesis. The marrow struggles to produce proper red cells, causing anemia that is more severe than in trait but not as constant as in major. Patients often need transfusions, and iron overload becomes a concern from both repeated transfusions and increased intestinal iron absorption due to the erythropoietic drive. Clinically you’d see a more pronounced microcytic, hypochromic anemia with evidence of ongoing erythropoiesis, and splenomegaly from extramedullary hematopoiesis. This distinguishes it from mild anemia with no transfusion need (thalassemia trait), from conditions with acute hemolysis, and from normal hematologic indices.