The consequence of repeated blood transfusions in thalassemia is iron overload in different organs. Magnetic resonance imaging (MRI) is a reliable, noninvasive and accurate method for iron detection in various tissues, hence the introduction of MRI has revolutionized the management of these patients and improved the life expectancy of them. Cardiac MRI T2* has a profound effect not only on estimation of severity of cardiac siderosis, but on intensification of chelation regimens and survival of patients. Liver hemosiderosis is also a common morbidity among thalassemia patients, since the liver represents the dominant iron storage organ in the body; however, the relationship between total body iron and liver iron concentration (LIC) is challenging. Pancreatic iron overload occurs in 75-100% of patients with thalassemia major, but the association between pancreatic R2* and development of diabetes mellitus has not been established in the studies. On the other hand, there is a strong correlation between pancreatic R2* and cardiac R2*, so pancreatic R2* could predict left ventricular function. The most prevalent endocrinopathy in patients with thalassemia is hypogonadotropic hypogonadism which has been correlated with pituitary iron overload. Published data about kidney and adrenal MRI is limited, and further studies are needed to determine their clinical significance.

Dear Editor,There are a considerable number of transfusiondependent thalassemia (TDT) patients in Iran,and the costs for the treatment of these patients are overwhelming for the health system.1 Iron deposition in the vital tissues of TDT patients seems to be an inevitable phenomenon,which has been reported to be correlated with age,the volume of blood transfusion,and serum ferritin levels.2 Cardiac failure due to iron deposition is the main cause of mortality in TDT patients,and therapeutic interventions,particularly conventional iron chelation regimens,largely fail to prevent this unfortunate outcome.3 This is mainly because iron chelators,despite promoting a fall in ferritin levels,are ineffective in reducing iron accumulation in the heart...

Background and Aim: Cardiac complications due to Iron overload are the most common cause of death in B-thalassemicpatients. Although regular blood transfusions in thalassemia major(TM) patients have improved the quality oflife of the patients but the most important complication of such transfusions is iron overload in cardiac tissues. In spite of iron overload in untransfused thalassemia intermedia (TI) patients, the intestinal absorption of iron increases in these patients because of ineffective erythropoesis. The aim of this study was to evaluate cardiac status in thalassemia major and intermedia patients and the investigation of the possible effect of iron overload in the heart of B-thalassemicpatients.Material and Methods: 46 patients entered into this study. 26 patients had thalassemia major with regular blood and also chelator transfusions and 20 patients with thalassemia intermedia who had not received regular transfusions. The age' of the patients in the 2 groups were similar. The results of clinical evaluation and echocardiographies of the patients of the 2 groups were compared with each other. Collected data were analyzed by means of X2 and man whitney U tests.Results: Heart failure occurred in two patients with TM (9.52%) and one patient with TI (4.76%). Considerable pulmonary hypertension (systolic tricuspid gradien~ >35mmHg) was only present in 3 patients with TI (14.28%). But systolic dysfunction of left ventricle (ejection ftaction<55% or shortening ftaction<35%) occurred in 5 patients with TM (23.8%). In the patients without apparent heart disease, cardiac dimensions, LV mass, LV shortening and ejection ftactions, cardiac output and valvular involvement were significantly more in patients with TI. But the maximum speed of systolic flow out of mitral valve in primary phase was higher significantly in TM patients than TI patients.Conclusion: Regular lifelong transfusion and chelation therapy in TM patients prevents premature heart disease and pulmonary hypertension, but LV dysfunction can occur and lead to heart failure. In contrast in TI patients left ventricular function is normal but pulmonary hypertension occurs which may lead to heart failure. Left ventricular performance is better preserved when chelation treatment is adjusted to maintain the serum ferritin concentration at <1000 nglml.

Introduction: Individuals who receive regular blood products, such as those with thalassemia, are at an elevated risk of contracting the hepatitis B virus (HBV). The objective of this study was to ascertain the correlation between HBV immunity and serum aminotransferases and iron indexes in transfusiondependent thalassemia patients who have received the HBV vaccine.Materials and Methods: This cross-sectional analytical study was conducted on 84 thalassemia patients in Jahrom-2024. Demographic information, serum levels of antibodies against HBV, and aminotransferases were extracted from the patient files. Serum ferritin and iron levels were determined by ELISA and spectrophotometry, respectively. The data was analyzed using SPSS-23, employing descriptive statistics (frequency and frequency percentage, mean and standard deviation) and analytical statistics (Chi-square and independent t tests).Results: Of the 84 patients included in the study, 52.4% were male, and 89.3% of them were immune to the HBV. No significant differences were observed in terms of age, sex, or history of splenectomy in relation to HBV immunity status (P>0.05). A statistically significant difference was observed in the mean values of ferritin, iron and TIBC between immune and non-immune patients (p<0.05). However, no significant difference was found in the mean values of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and between the two groups (p>0.05).Conclusion: In the studied patients, there was a significant inverse relationship between immunity to the HBV and the serum level of ferritin and iron. However, no statistically significant relationship was observed between immunity and the serum level of AST and ALT. Further studies are recommended to investigate the role of these factors and liver diseases on immunity to HBV.