Iron overload in β-thalassemia intermedia: an emerging concern

Purpose of review The aim is to overview recent evidence on consequences, assessment, and management of iron overload in transfusion-independent patients with beta-thalassemia intermedia. Recent findings Despite their transfusion-independence, beta-thalassemia intermedia patients can still accumulate iron due to increased intestinal absorption. Recent observational studies show that iron burden in this group of patients can ultimately reach considerably high thresholds, and leads to a variety of serious morbidities involving the liver, endocrine glands, and arguably the vascular system. The diagnosis of iron overload in this patient population can follow established guidelines from beta-thalassemia major patients, although with careful interpretation of spot serum ferritin levels. Data from a recent randomized clinical trial demonstrated the efficacy and safety of iron chelation therapy in decreasing liver iron concentration in this group of patients, which may ultimately help in reducing morbidity risk. Summary Iron overload in transfusion-independent patients with beta-thalassemia intermedia deserves careful attention, and prompt diagnosis and management are recommended.