A reader asks: I have the thalassaemia gene and although I have been asymptomatic for most of my life, just carrying the gene and having small red blood cells, I now seem to be having trouble keeping cool in hot weather and warm in cold weather. I am 71 and, apart from mild hypertension, in fairly good health. Is it just part of the normal ageing process or am I now getting symptoms of the condition? 

Dr Rosemary Leonards says: Thalassaemia is an inherited condition where the haemoglobin, the chemical that carries oxygen in red blood cells, is faulty. There are two main parts of haemoglobin, known as alpha chains or beta chains, and thalassaemia can affect either. In addition, each type – alpha or beta – is classified into more types, depending on how many faulty genes are involved, as there are four genes for the alpha chain and two for the beta chain.

In the mildest type, which is known as thalassaemia trait, you have one or two faulty alpha genes, or one faulty beta gene but can still make enough normal haemoglobin and have no symptoms. It sounds as if this is the type you have.

Many people with thalassaemia trait are unaware they have it until they have a blood test, which shows the red blood cells are slightly smaller and paler than normal. It is very unlikely your thalassaemia is to blame for your temperature control issue. These may be an indicator of a problem with your circulation or a side effect of medication you are taking to help control your blood pressure. I suggest you mention it to your doctor next time you have a check-up.

If you have a health question for Dr Leonard, email her in confidence at [email protected]. She regrets she cannot enter into personal correspondence or reply to everyone

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