Effect of Benson's Relaxation Technique Versus Music Therapy on Physiological Parameters and Stress of Children With Thalassemia During Blood Transfusion

Thalassemia is the most common hematological disease in Egypt and the world that is transmitted by parents to their children and has no definitive cure. It means a group of hereditary blood diseases caused by defects haemoglobin (Hb) synthesis that results from an alteration in the gene responsible for producing globin chains leading to alteration in the rate of its production .

Generally in worldwide, There are about 300 million thalassemia patients, 55 million of whom live in Southeast Asia . In Egypt, beta-Thalassemia represents a major public health problem. It is reported that the carrier rate is between 9 to 10% of the population. It has been estimated that one thousand children out of 1.5 million live births are born each year suffering from thalassemia. In spite of optimal treatment being available, only a few children can afford it. Unfortunately, most children suffer from complications of blood transfusions, mainly transfusion transmitted viral infections and iron overload. Prevention by carrier detection and prenatal diagnosis is needed in populations with high incidence of the disease, such as Egypt.

The most severe form is the β-thalassemia major, which is characterized by a severe microcytic, hypochromic anemia (Cooley's anemia), whose symptoms appear usually within the first 2 years of life due to iron overload. Chronic iron overload can occur in children with beta-thalassemia as may need blood transfusions throughout their life. Iron overload can lead to growth retardation, pallor, poor appetite, and often jaundice; as well as hinder sexual development during the adolescent period and dysfunction of organs, such as heart, pancreas, and endocrine glands.

When the storage capacity of the body is exceeded, iron remains in free form. The formation of hydroxyl free radicals can be catalyzed by this free iron, leading to damage of cell membranes and protein denaturation. Ultimately, tissue damage occurs which can lead to significant levels of morbidity and mortality. Iron chelation helps prevent complications of iron overload due to repeated blood transfusion. Indeed, the most common complication of beta-thalassemia that leads to death is organ failure, in children taking regular blood transfusions and no appropriate iron chelation. Elevated liver iron concentrations (LICs) and serum ferritin levels can manifest within 1-2 years of starting regular blood transfusions. Children with thalassemia whose serum ferritin level is more than 2500 ng/mL or LIC value is more than 15 mg Fe/kg dry weight are at high risk of development of cardiac diseases such as cardiomyopathy.

Significant advances in treatment modalities and improved clinical management have led to a substantially higher life expectancy of these children. Children with thalassemia major have good survival but little is known about their psychological status. children are less able to voice their concerns and are more vulnerable than adults.