BETA THALASSEMIA MAJOR

ALTERNATE NAMES

Beta Thalassemia Major Syndrome; Beta Thalassemia Major Disease; Thalassemia Major; Cooley Anemia; Cooley Anemia Disease; Cooley Anemia Syndrome; Erythroblastic Anemia of Childhood; Microcythemia Major; Mediterranean Anemia Major; Beta Zero Thalassemia

DESCRIPTION

Beta Thalassemia Major (BT major) is a hereditary blood disorder where the bone marrow is unable to produce the beta chain of hemoglobin, resulting in chronic anemia and lowered ability of the blood to transport oxygen to cells. BT major is the most severe type of thalassemia (the other types are BT intermedia and BT minor.) BT major requires regular lifelong blood transfusions, and the affected individuals are considered to be “transfusion-dependent.” Over time, the chronic blood transfusions lead to a buildup of iron in the body (iron overload) and require iron chelation therapy.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING

Diagnostic testing:

• •

  Complete blood count (CBC);

• •

  Reticulocyte counts;

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  Hemoglobin electrophoresis;

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  Quantitative hemoglobin A2; and

• •

  Quantitative hemoglobin F.

Physical findings:

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  Poor growth/failure to thrive;

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  Delayed puberty;

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  Pallor;

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  Jaundice (yellowish color of the skin or whites of the eyes);

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  Enlarged spleen, liver, or heart; and

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  Skeletal abnormalities (especially the bones in the face).

ICD-9: 282.44

ICD-10: D56.1

PROGRESSION

Signs and symptoms of BT major usually occur within the first 2 years. Children develop life-threatening anemia, have failure to thrive, and may develop jaundice. People with BT major are prone to complications such as infection and osteoporosis.

TREATMENT

Life-long blood transfusions at least once every six weeks are required for BT major; iron chelation therapy once significant iron overload occurs; and folic acid supplements. Stem cell transplant and gene therapy are the only treatments that can cure BT major. Without transplantation or gene therapy, death by age 20 is common.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

• •

  Clinical history and examination that describes diagnostic features, physical findings, and treatment;

• •

  Laboratory reports documenting hemoglobin levels and electrophoresis;

• •

  Iron studies to document iron overload or liver toxicity; and

• •

  Genetic tests such as human leukocyte antigen (HLA) typing may be done to evaluate for potential bone marrow transplantation but are not required for diagnosis.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

7.05 D

Beta Thalassemia Major with “Red blood cell transfusion-dependency” is consistent with listing level severity.

7.17

Beta Thalassemia Major with “Red blood cell transfusion-dependency” is consistent with listing level severity.

Reevaluate adult Beta Thalassemia Major at least 1 year after bone marrow or stem cell transplantation.

107.05 D

Beta Thalassemia Major with “Red blood cell transfusion-dependency” is consistent with listing level severity.

107.17

Beta Thalassemia Major with “Red blood cell transfusion-dependency” is consistent with listing level severity.

Reevaluate child Beta Thalassemia Major at least 1 year after bone marrow or stem cell transplantation.

7.17

Beta Thalassemia Major treated with gene therapy such as Zynteglo (betibeglogene autotemcel) and Casgevy (exagamglogene autotemcel) medically equals listing 7.17.

Reevaluate adult Beta Thalassemia Major treated with gene therapy at least 1 year after the date of transplantation.

107.17

Beta Thalassemia Major treated with gene therapy such as Zynteglo (betibeglogene autotemcel) and Casgevy (exagamglogene autotemcel) medically equals listing 107.17.

Reevaluate child Beta Thalassemia Major treated with gene therapy at least 1 year after the date of transplantation.