Review Articles
Vol. 18 No. 1 (2026): Mediterranean Journal of Hematology and Infectious Diseases
AGING WITH THALASSEMIA AND SICKLE CELL DISEASE: A GERONTOLOGICAL MODEL OF ACCELERATED MULTIMORBIDITY AND FUNCTION-CENTERED CARE BEYOND MIDLIFE
Thalassemia and Sickle Cell Diseases: Effect of Aging
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: April 30, 2026
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Background. Thalassemia major and sickle cell disease now present as lifelong chronic conditions, with median survival extending into the 50s and 60s. This unprecedented shift transforms hemoglobinopathies from childhood emergencies into models of accelerated aging and cumulative multimorbidity, yet clinical literature remains pediatric-focused, leaving hematologists and internists unprepared for the functional and cognitive decline, vulnerability, and geriatric syndromes that characterize later life in these populations.
Content. This review synthesizes evidence on the intersection of disease-driven pathology (anemia, hemolysis, vasculopathy), treatment burden (transfusion-related iron overload, chelation nephrotoxicity), and aging biology (weakness, indicators of aging, organ reserve depletion) in patients aged 45 years and older. We distinguish disease-specific priorities: thalassemia faces myocardial and hepatic iron deposition and endocrine failure, while sickle cell disease confronts cerebrovascular disease, chronic pain, and pulmonary complications.
Critically, we reframe the clinical target from survival and organ-specific metrics to functional endpoints, disability prevention, cognitive health, and quality of life. A conceptual mapping links hemoglobinopathy mechanisms to established gerontology constructs (inflammaging, cellular senescence, vascular aging), revealing shared pathways between genetic disease and age-related decline.
Conclusions. Three adjustments are necessary: (1) monitoring must detect treatable complications early rather than recording cumulative damage; (2) therapeutic decisions must weigh treatment acceptance, comorbidity burden, and life expectancy rather than defaulting to pediatric protocols; (3) care systems must embed palliative principles, shared decision-making, and multidisciplinary coordination into primary networks. Future research must prospectively characterize aging cohorts, test interventions to slow functional decline, and prioritize patient-reported outcomes and disability prevention alongside mortality.
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Ethics Approval
Hemoglobinopathies; Thalassemia; Sickle Cell Disease; Aging; Multimorbidity; Frailty; Geriatric Assessment; Chronic DiseaseSupporting Agencies
All authors declare no conflict of interest. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.How to Cite
“AGING WITH THALASSEMIA AND SICKLE CELL DISEASE: A GERONTOLOGICAL MODEL OF ACCELERATED MULTIMORBIDITY AND FUNCTION-CENTERED CARE BEYOND MIDLIFE: Thalassemia and Sickle Cell Diseases: Effect of Aging” (2026) Mediterranean Journal of Hematology and Infectious Diseases, 18(1), p. e2026039. doi:10.4084/MJHID.2026.039.
Copyright (c) 2026 Dr.Sophia Delicou, Dr.Ioannis Ilias, Dr.Athanasia Kapota, Dr.Elena Papatheodorou, Dr.Maria Moraki, Dr.Aikaterini Xydaki, Dr.Alexandra Mika, Dr.Panagiota Giannou, Dr.Irene Kouroukli, Dr.Theodoros Aforozis, Dr.Myrto Palkopoulou, Dr.Christos Savvidis, Dr.Iliana Mani, Prof.Constantina Aggeli, Prof. John Koskinas
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