Among patients with thalassemia requiring frequent transfusions, which complication is of major concern?

• A. Aplastic anemia
• B. Chronic kidney disease
• C. Iron overload
• D. Vitamin B12 deficiency

Answer: (C)

Frequent transfusions in thalassemia lead to iron overload because the body has no good way to excrete the excess iron from red blood cells. Iron accumulates in tissues such as the liver, heart, and endocrine glands, causing progressive organ damage—liver fibrosis or cirrhosis, cardiomyopathy or heart failure, and endocrine problems like diabetes or hypogonadism. This buildup is the major long-term risk of chronic transfusion therapy, which is why iron overload is the primary concern. Monitoring with ferritin levels and imaging or biopsy to assess organ iron helps guide treatment, typically with iron chelation therapy to remove the excess iron. Aplastic anemia, chronic kidney disease, and vitamin B12 deficiency are not the central transfusion-related complications in this scenario.