Complications

Cardiac
All children should have a regular cardiological assessment from the age of 10 (1)
From the age of 8 years myocardial iron should be monitored by Cardiac T2* (1)

Endocrine
Children should be monitored for growth and development until sexual maturity and reaching full adult height. This can be due to pituitary damage resulting in growth hormone and gonadotrophin deficiency, presenting as short stature, delayed/absent puberty, and infertility. (1)
Other problems involving endocrine system are glucose intolerance, diabetes mellitus, hypothyroidism and hypoparathyroidism. (1)
From the age of 10 years annual monitoring for glucose intolerance and from 12 years for hypothyroidism and hypoparathyroidism (1)

Liver
Liver iron toxicity leads to hepatic fibrosis eventually leading to cirrhosis, liver failure and hepatocellular carcinoma.
Liver enzymes should be monitored regularly (1)
Vaccination of Hepatitis B should be standard Practice (1)

Bone
Prompt transfusions should be started to prevent permanent deformities (1)
Bone changes related to desferrioxamine toxicity should be suspected and investigated (1)
Patients have to adviced regarding exercise and maintain a diet rich in calcium and vitamin D, avoid smoking and excessive alcohol consumption (1)

Fertility and Pregnancy
Women contemplating pregnancy needs to be assessed for risks to themselves and the baby. (1)

Complications of blood transfusions
Acute transfusion reactions, allo-immunisation to red cell antigens, transmission of viral infection and, in the long-term, iron overload (1)

Reference:

• (1) Standards for the Clinical Care of Children and Adults with Thalassaemia in the UK, United Kingdom Thalassaemia Society 2008