Hi Brooke,

Apologies for the delayed reply. The issue of concern is likely to be the iron content of therapeutic foods and the desire to avoid high iron content in the diet of thalassaemic patients. Even in the non-transfused thalassaemia intermedia patient we would prefer a moderately low iron diet. 

For the child with SAM and thalassaemia in an inpatient unit we can feed with F75 in stabilisation and F100 (without added iron) in the rehabilitation phase. In the outpatient setting there is less choice. Therapeutic foods such as RUTF / BP100 have high iron content but the clinical need to treat SAM likely outweighs the concerns about the food's iron content. 

A couple of workarounds for oupatient cases might be used.

1. You could potentially reduce the dose of RUTF in recovery. Start at approximately 150kcal / kg / day. When the child reaches a MUAC or WFH that indicates MAM (rather than SAM) reduce the dose to 1 packet per day until recovery. 

2. Although not normally recommended, giving meals with black tea reduces the amount of iron absorbed. With children you would want to limit the amount of caffeine. I don't have any information on how effective this approach would be. 

I hope this helps,

Paul

P.S. Thanks to Dr. Indi Trehan for his discussion and inputs.