Differential diagnosis of a probable case of non-adult thalassaemia from 4th century AD Romano-British Colchester, UK

Our current understanding of immigration and diasporic disease in Roman Britain has been greatly enhanced by the recent identification of thalassaemia in the non-adult skeletal record. The wide phenotypic variation in the clinical expression of β-thalassaemia, however, means that additional cases may go unrecognised. A probable diagnosis for β-thalassaemia intermedia or a mild form of major in a 1.0-1.5 year old skeleton from Butt Road, Colchester, dating to the 4th century AD is discussed here. The assessment was undertaken using macroscopic and radiographic analysis. Several conditions were apparent, including trauma and probable β-thalassaemia and active vitamin D deficiency. Diagnosis proved difficult due to the challenges that non-adult thalassaemia poses for identification in the skeletal record, as in the absence of the cranium only 'rib-within-a-rib' is currently considered as pathognomonic of the condition. This case demonstrates the variations in expression of this type of genetic anaemia and adds emphasis to a more widespread presence of this important condition in Roman Britain.