The heat waves are rising all over the world and causing a lot of damage. While there are issues of dehydration and heat strokes, studies are suggesting that it might also be responsible for declining mental health, the heat among other things is not only affecting the physicality of human beings but is also having adverse mental health.

Emotional distress: The heat can trigger mood swings, making you feel irritable, anxious, depressed, or even aggressive. You may not be able to predict your reaction, you may be good one moment and then any minor inconvenience will make you angry or sad. Heat often triggers that helplessness in people.

Scattered Focus: Concentrating on tasks becomes a struggle when it's hot. Simple things feel overwhelming, and staying focused is a challenge. While you may be in the zone working on completing something, the heat and sweating will disrupt your flow and then you will not be able to focus on anything other than the heat.

Sleepless Nights: High temperatures, especially at night, disrupt your sleep. This lack of rest can leave you feeling tired, and grumpy, and worsen existing mental health issues. All humans require a comfortable temperature to sleep in, if your body is too wound up or heated up, it will not be able to relax and sleep.

Feeling the Pressure: The heat can pile on stress and make you feel overwhelmed. Concerns about the heat itself or its impact on other aspects of your life can contribute to this feeling. You will feel overwhelmed and unable to work on anything else. The heat makes you feel a certain helplessness, as you cannot stop the sun or turn down the heat.

Body Blues: The heat can cause physical symptoms that affect your mental well-being. Headaches, fatigue, dizziness, and nausea can all contribute to anxiety and low mood. When your body is already fatigued, the urge to do anything else disappears. Your body is drained of energy to function at all and will seek rest and sleep.

Behavioural Shifts: The heat can influence your behaviour. You might act impulsively or have difficulty managing anger. It's like the heat turns up your emotional thermostat. When your body and brain are overheating, it is difficult to think straight and you will grasp at straws to release this energy and pressure off of you.

Some other side effects of the heat are.

• Mental Health Flare-Ups: If you already have a mental health condition, hot weather can worsen your symptoms. Existing depression, anxiety, bipolar disorder, or schizophrenia might feel more intense.
• Heat and Suicide Risk: Studies show a disturbing link between hot weather and increased suicide rates, particularly among men and older adults. Hot weather can be a tipping point for those already struggling.
• Heatwave Hospitalizations: When temperatures soar, people with existing mental health issues may require increased hospitalization. This highlights the need for healthcare systems to be prepared for heat waves.
• Climate Change and Mental Health: Climate change is leading to more frequent heatwaves. Research suggests this could lead to a rise in mental health problems and suicides. Taking action against climate change is crucial for protecting mental well-being.

Thalassemia, particularly thalassemia major and thalassemia intermediate, can affect fertility and pregnancy due to iron overload caused by repeated blood transfusions. In these patients, excess iron gets deposited in various endocrine and vital organs, leading to hormonal disturbances and fertility-related complications.

Patients with thalassemia major usually require regular blood transfusions for survival, sometimes every one to three months. Thalassemia intermediate patients may require fewer transfusions, but they too remain at risk of iron overload. Over time, excess iron can accumulate in organs such as the pituitary gland, thyroid, ovaries, kidneys, liver, and suprarenal glands. This iron deposition can impair hormonal function and contribute to infertility. Experts note that many patients with thalassemia major may face fertility issues because of this reason.

Pregnancy In Women Living With Thalassemia

Dr. Sunil Bichile, Hematologist, Saifee Hospital, Mumbai, said, "Although thalassemia management has improved significantly over the years, pregnancy in such patients is still considered high-risk. " Even when iron levels are properly managed, risks to both the mother and fetus may still exist. However, these complications are mainly seen in thalassemia major and thalassemia intermediate patients. Individuals with thalassemia minor generally do not face these fertility or pregnancy-related issues and can have normal pregnancies."

"Doctors also emphasise the importance of carrier screening and prenatal diagnosis. If both partners are thalassemia carriers, prenatal testing around 12 weeks of pregnancy can help determine whether the fetus has thalassemia major. Early diagnosis allows families and doctors to make informed medical decisions and helps reduce severe thalassemia cases," Dr Bichile added.

Ensuring Healthy Pregnancies In Women Living With Thalassemia

Women with thalassemia are now increasingly able to experience healthy pregnancies due to advances in medical care. However, one of the most important concerns during pregnancy in thalassemia patients is iron overload—a condition caused by repeated blood transfusions over many years. Excess iron gets deposited in vital organs such as the heart, liver, and endocrine glands, potentially leading to serious complications if not managed properly before conception and during pregnancy.

How Does Iron Overload Affect Pregnancy?

"Iron overload can significantly increase pregnancy-related risks. When excess iron affects the heart, it may lead to cardiac complications such as arrhythmias or heart failure, which can worsen during pregnancy because of the increased workload on the cardiovascular system. Iron deposition in endocrine glands may also cause hormonal imbalances, affecting fertility and increasing the risk of gestational diabetes, thyroid disorders, or difficulties in maintaining a healthy pregnancy," Dr Liza Bulsara, Pediatric Hematologist and Oncologist, Ruby Hall Clinic, Pune, explained.

Women with poorly controlled iron overload may face a higher chance of miscarriage, fetal growth restriction, preterm delivery, or complications during childbirth. In some cases, liver dysfunction caused by iron accumulation can further complicate pregnancy management. Additionally, anaemia associated with thalassemia itself may increase fatigue and reduce oxygen supply to both mother and baby if not carefully monitored.

Dr Bulsara emphasised that pre-pregnancy counselling is essential for women with thalassemia. A detailed assessment of iron levels through serum ferritin tests and MRI evaluation of the heart and liver helps doctors determine whether the body is prepared for pregnancy. Proper iron chelation therapy before conception plays a crucial role in reducing excess iron stores and improving maternal outcomes. During pregnancy, transfusion schedules, haemoglobin levels, cardiac health, and fetal growth require close multidisciplinary monitoring.

Thalassemia is a hereditary illness that hampers the production of haemoglobin, the component of red blood cells that carries oxygen throughout the body. If the production of haemoglobin is faulty or reduced, a shortage of healthy red blood cells occurs, resulting in anaemia and reduced oxygen supply to the organs.

"Thalassemia is, in fact, a collection of conditions ranging from a simple carrier state with no symptoms to a very severe disease requiring lifelong treatment. Mostly, thalassemias are classified into alpha and beta types, depending on which chain of the haemoglobin molecule is defective," said Dr Sneha Shinde, Consultant – Paediatric Haemato-Oncology, P.D. Hinduja Hospital and MRC Centre, Khar.

As per National Health Mission figures, nearly 42 million people in India are beta thalassemia carriers, and about 10,000 to 15,000 infants with thalassemia major are born every year.

What are the causes of thalassemia?

This disease is inherited from parents through genes. If both parents are carriers, their child may develop a severe type of the disease.

What are the symptoms of thalassemia?

Symptoms largely depend on the severity of the illness and can include tiredness, weakness, pale complexion, difficulty breathing, stunted growth, enlarged spleen or liver, and changes in facial bones. Most severe cases become apparent during infancy or the toddler years.

Dr Shashikant Apte, Director – Haematology, Sahyadri Super Speciality Hospital, Nagar Road, said, "Symptoms can vary from person to person. Some individuals may simply feel low on energy, while others may notice pale skin, shortness of breath, or delayed growth in children. Because these signs are common, they are often ignored or mistaken for general weakness. The majority of children with thalassemia major require blood transfusions every month for the rest of their lives to maintain haemoglobin levels above 9 gm%."

Diagnosis and Treatment

Dr Shinde explained that diagnosis comprises blood tests such as Complete Blood Count (CBC), HPLC haemoglobin electrophoresis, and genetic analyses. Mild cases may hardly need treatment, but more serious or transfusion-dependent thalassemia cases usually require regular blood transfusions along with iron chelation therapy to avoid iron overload. Besides bone marrow transplantation and newly discovered gene therapies, treatment advancements are gradually leading to better patient survival and improved quality of life.

Dr Apte said, "The positive aspect is that thalassemia can be detected with a simple blood test. Early diagnosis helps in managing the condition more effectively. Therefore, it is advisable to undergo screening for thalassemia before marriage or before planning a pregnancy, so the level of risk can be assessed. If both parents are thalassemia minor carriers, DNA testing should be conducted to identify the genetic defect and enable prenatal diagnosis during the 12th week of pregnancy. If the child is diagnosed with thalassemia major, pregnancy termination may be considered between the 14th and 16th week, based on medical advice and individual circumstances."

Prevention and Awareness

Of equal significance is the fact that thalassemia can be prevented through premarital or pre-pregnancy carrier detection and genetic counselling. Early awareness, proper diagnosis, and making informed reproductive choices are the key factors in reducing the burden of this lifelong blood disorder.

Dr Shashikant Apte, Director – Haematology, Sahyadri Super Speciality Hospital, Nagar Road, spoke about the incidence of constant fatigue and answered FAQs about thalassemia major, while sharing tips on living with it.

Why Constant Fatigue Should Not Be Ignored

Being tired every day is typically attributed to a busy lifestyle; however, it can also have underlying medical reasons. Thalassemia is one of the conditions a person is born with that can cause fatigue due to a lack of oxygen. Thalassemia is a disorder in which the proper formation of haemoglobin — the protein in blood responsible for carrying oxygen — does not occur correctly. When haemoglobin is not formed properly, the body does not receive enough oxygen, leading to frequent tiredness and weakness.

Understanding Thalassemia Major and Carrier Status

Thalassemia major is an inherited disorder, meaning it is passed down from both parents to their child. Some individuals may simply be carriers without displaying any symptoms. During each pregnancy, there is a 25 per cent chance of passing the abnormal gene to the foetus, which may result in severe complications related to thalassemia major or other conditions associated with a lack of oxygen. Therefore, it is critical to know your family’s medical history and thalassemia minor (carrier) status.

Living with Thalassemia

Dr Apte went on to say that although thalassemia is a chronic condition, there are highly effective ways to manage it with proper medical guidance. Regular medical check-ups and prompt treatment can help individuals maintain good overall health and lead a normal life.

Understanding thalassemia is the first step towards prevention and better management. Awareness allows individuals and families to make informed decisions and avoid complications before the condition becomes severe.

World Thalassemia Day is observed every year on May 8 to raise awareness about the inherited blood disorder caused by faulty genes.

The day was initiated in 1994 by the Thalassaemia International Federation in memory of George Englezos, the son of the federation’s founder, who succumbed to the disease.

This year’s theme, “Together for Better Care and Equal Access,” highlights the need for universal screening, safe blood availability, and advanced therapies.

The disorder, which often requires blood transfusions every fortnight, affects approximately 1.3 million people living with severe forms of thalassemia worldwide. About 1.5 percent of the global population is carriers, and the disease claims nearly 11,000 lives annually.

More than 40,000 infants are born each year with severe thalassemia, predominantly in low- and middle-income countries. Although mortality rates have declined, they remain high in developing regions, particularly in Southeast Asia.

What Is Thalassemia?

Thalassemia is an inherited hemoglobin disorder caused by defective synthesis of alpha or beta globin chains.

In β-thalassemia major, reduced or absent beta-chain production leads to ineffective erythropoiesis, severe anemia, bone marrow expansion, splenomegaly, growth retardation, and iron overload due to repeated blood transfusions.

Patients often present in early childhood with pallor, jaundice, recurrent infections, and characteristic facial bone deformities.

Thalassemia Screening

With 10,000–15,000 babies born with Thalassemia Major every single year in India, the country remains one of the global hotspots for the blood transfusion-dependent disease.

HealthandMe spoke to doctors who emphasized that carrier screening, premarital counseling, and antenatal diagnosis remain crucial preventive strategies in India, often referred to as the “thalassemia capital of the world”, as nearly one in every eight thalassemia patients globally lives in the country.

Experts stressed that normalizing conversations around screening is key to reducing the disease burden.

Dr. Ajay Sharma, Director and Head of Hematology and Hemat-Oncology at Paras Health Panchkula, said thalassemia is a preventable genetic disorder, but continues to go undetected until it is too late.

This is because “thalassemia screening, which is one of the simplest yet most overlooked preventive steps in India,” said Dr. Vishnu Hari, Associate Director and Head of Haematology & BMT at Sarvodaya Hospital, Faridabad.

“Every couple, especially those planning marriage or pregnancy, should undergo basic carrier screening. The challenge is not the availability of tests, but the lack of awareness and social hesitation around genetic conditions,” Dr. Hari said.

Also read: Reused Syringes Infect Over 330 Children in Pakistan With HIV: Report

When To Get Screened?

Screening should ideally be done early, as early detection helps informed decision-making and prevents severe health complications in children. Experts recommend screening:

• At the premarital stage
• At the start of pregnancy

What Will the Screening Find?

Carrier detection is possible with a complete blood count and a test called High Performance Liquid Chromatography (HPLC). Indicators include:

• Low haemoglobin (~9 g/dL)
• Low MCV (Mean Corpuscular Volume, ~65)
• HbA2 levels above 3.5%

“If both partners are carriers, timely genetic counselling during the antenatal phase becomes critical,” he said.

While cultural stigma and low prioritization of preventive healthcare often delay this step, the integration of routine thalassemia screening into premarital check-ups and early pregnancy care can help significantly reduce the number of affected births in India.

What Could Be Done To Manage Thalassemia?

Dr Parveen Yograj, a General Surgeon from Jammu, in a post on the social media platform X, shared that treatment for thalassemia has evolved remarkably over recent decades.

“Regular blood transfusions combined with iron chelation therapy using agents like Deferasirox and Deferiprone have significantly improved survival. Curative therapy through bone marrow transplantation is now increasingly successful, especially in children with matched donors.

"Recent breakthroughs in gene therapy and CRISPR-based genome editing offer new hope for a long-term cure by correcting defective globin gene expression,” he said.