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Transfusional Iron Overload — RACP Adult Medicine MCQ

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ModerateHaematologyTransfusional Iron OverloadRACP Adult Medicine

A 30-year-old man with beta-thalassaemia major on chronic transfusion therapy (2 units every 4 weeks) has a ferritin of 3500 μg/L. Cardiac MRI T2* is 12 ms (normal >20 ms, indicating cardiac iron loading). He cannot tolerate venesection due to anaemia. What is the most appropriate treatment?

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Correct answer: D — Iron chelation therapy (deferasirox)

Transfusional iron overload in thalassaemia major cannot be managed by venesection (patient is already anaemic). Iron chelation therapy is required. Deferasirox (oral, once daily) is first-line for transfusional iron overload. Cardiac T2* <20 ms indicates cardiac iron loading requiring intensified chelation (deferasirox + deferoxamine combination or 24-hour deferoxamine infusions).

Reference: HSANZ – 2024 – Thalassaemia Guidelines; TIF 2024