Transfusional Iron Overload — RACP Adult Medicine MCQ

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ModerateHaematologyTransfusional Iron OverloadRACP Adult Medicine

A 70-year-old man with myelodysplastic syndrome has been receiving regular red blood cell transfusions (2 units every 2 weeks for 18 months – approximately 70 units total). His ferritin is 4,500 µg/L. What complication of transfusional iron overload should be assessed?

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Correct answer: D — Cardiac iron loading (cardiac T2* MRI)

Transfusional iron overload occurs after ~20 units of RBCs (each unit contains ~200–250 mg iron). At 70 units, this patient has received ~14–17.5 g of excess iron. Cardiac iron loading is the most dangerous complication (causes cardiomyopathy and arrhythmias – the leading cause of death in transfusional siderosis). Cardiac T2* MRI is the gold standard for assessing cardiac iron (T2* <20 ms indicates iron loading; <10 ms indicates severe loading requiring urgent chelation). Liver MRI (R2 or T2*) also assesses hepatic iron. Iron chelation (deferasirox oral, or desferrioxamine SC infusion) is indicated when ferritin persistently >1000 µg/L after ~20 transfusions.

Reference: eTG – 2025 – Haematology; National Blood Authority – 2024