Nursing Assessment 

If you observe a child of thalassemia major you can identify the following clinical  manifestations: 

Anaemia with haemoglobin level of 3 to 8 gm per cent and hepatosplenomegaly, bone changes as a result of anoxia due to severe anaemia which presents with prominent cheeks, globular enlargement of  the head, depressed bridge of  the nose, mongoloid slant, protruding maxilla and a receding lower jaw with widely spaced teeth. Epicanthic folds near the medial aspect of  the eyes are common. The child may have congestive heart failure. 

Diagnostic evaluation includes laboratory estimation of foetal hemoglobin levels which shows a range of  50 and 90 per cent. 

Blood film shows excess of  reticulocytes and normoblasts with microcytic hypochromic anaemia. Serum iron studies indicate rise in serum iron and fall in iron binding capacity. Bone marrow test show hyper plastic and normoblastic marrow with excess of  intracellular and extracellular haemosiderin (an insoluble form of  iron stored in the tissues), and large number of  normoblasts containing excess of  haemosiderin in the bone marrow X-ray of  the skeleton show widening of medullary cavity.