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As iron continues to build up in the body, complications happen more often


of deaths in thalassemia major patients are due to cardiac disease and complications.

Causes of death in thalassemia patients until the late 1990s

Monitor for renal/hepatic toxicity

Regular monitoring of both renal and hepatic toxicity can help optimize chelation and ensure patients are on an appropriate chelator.

The only way to know if your patients’ iron chelator is working is to have their iron levels checked regularly

Iron chelation needs to be adjusted regularly or even switched depending on iron level, weight, and tolerance to side effects

Thalassemia treatment guidelines support regular monitoring of serum ferritin, and cardiac and liver MRI T2*.
ParameterTargetRecommended monitoring
Serum ferritin<1,000 ng/mLMonthly
Cardiac MRI T2*20 ms or higherAnnually (Or every 6 months for those patients with T2* <10 ms)
Liver iron concentration (LIC)<3,000 µg/g dry weightAnnually

Lowering serum ferritin and liver iron concentration are not enough.