Is beta thalessemia a hemolytic anemia?

[AspiringOne]

I always thought the anemia in beta thalessemia was more due to ineffective erythropoeisis rather than hemolysis, but today I encountered a Uworld question that called it "a severe hemolytic anemia." First Aid doesn't even include thalessemia in the "hemolytic anemias," but Goljan has one sentence stating that there is extravascular hemolysis along with ineffective erythropoesis. Is this what Uworld was referring to?

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[SeekerOfTheTree]

I always thought the anemia in beta thalessemia was more due to ineffective erythropoeisis rather than hemolysis, but today I encountered a Uworld question that called it "a severe hemolytic anemia." First Aid doesn't even include thalessemia in the "hemolytic anemias," but Goljan has one sentence stating that there is extravascular hemolysis along with ineffective erythropoesis. Is this what Uworld was referring to?

Yes. The problem with B-thal is that it's not normal. When those RBCs go through the spleen you will end up seeing them get slaughtered. The chains aren't supposed to be that way. That's why after babies are born the HbF gets eaten up by the macrophages in the spleen to gradually. This is the the same mechanism which is behind this hemolytic anemia. Extravascular is just referring to it being in the spleen versus happening in the blood vessels.