In beta-thalassemia major, the major cause of morbidity in adequately transfused patients (Hb maintained >9–10 g/dL) is iron overload from transfusion hemosiderosis. Which organ is MOST critically monitored using T2* cardiac MRI?

• A Liver, as it is the primary iron storage organ
• B Spleen, as splenomegaly indicates ineffective erythropoiesis
• C Pituitary, for early endocrine dysfunction detection
• D Heart (myocardium), as cardiac iron overload is the leading cause of death ✓

Explanation

Cardiac iron overload is the leading cause of death in beta-thalassemia major, causing cardiomyopathy, arrhythmias, and heart failure. T2* cardiac MRI (myocardial T2*) is the gold standard for non-invasive quantification of cardiac iron; T2* <20 ms indicates iron loading, and <10 ms indicates severe cardiac iron. This guides intensification of chelation therapy (deferasirox, deferoxamine). Liver T2* assesses hepatic iron but does not predict cardiac risk. Pituitary MRI helps identify hypogonadotropic hypogonadism from pituitary iron.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.