hemolytic anemia in beta-thalassemia?

[MudPhud20XX]

I didn't think you would see hemolytic anemia in beta thalassemia, but I just did a UW question that you had to know this. As far as I know when it comes to hemolytic anemia, I always think of some kinds of autoimmune, PNH, G6PD def etc....

Can anyone explain why you would get hemolytic anemia in beta-thalassemia. I don't really recall this from Pathoma either. What am I missing here? Thank you for the help.

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[SBR249]

Robbins has a very concise explanation for this on pg. 414 of the 9th edition:

Even more important is the imbalance in β-globin and α-globin chain synthesis, as this creates an excess of unpaired α chains that aggregate into insoluble precipitates, which bind and severely damage the membranes of both red cells and erythroid precursors. A high fraction of the damaged erythroid precursors die by apoptosis (Fig. 11–6), a phenomenon termed ineffective erythropoiesis, and the few red cells that are produced have a shortened life span due to extravascular hemolysis.