Better survival and less cardiac morbidity in female patients with thalassemia major: a review of the literature

Female patients with thalassemia and other hemoglobinopathies enjoy a longer survival when compared to males. We report data from the literature and from our own studies on gender differences in survival of thalassemia patients, and also examine this phenomenon in animals and in the general population. Some of the more widely accepted hypotheses that try to explain the differences in longevity between males and females are reviewed. The oxidative stress hypothesis is commonly accepted by the researchers on ageing, although further support for it is needed. In conclusion, it appears that male and female patients with transfusion-dependent thalassemia major are at the same risk of accumulating iron, but females survive longer and develop less cardiac disease because they tolerate iron toxicity better, possibly as an effect of increased tolerance to chronic oxidative stress.