A 30-year-old man with beta-thalassemia major on regular blood transfusion has serum ferritin of 4,500 ng/mL and liver iron concentration (LIC) of 18 mg/g dry weight on MRI. The PREFERRED oral iron chelation agent with the most extensive evidence and convenient once-daily oral dosing is:
- A Deferoxamine subcutaneous infusion nightly
- B Deferiprone (oral three times daily)
- C Deferasirox (oral once daily) ✓
- D Phlebotomy — most efficient chelation
Correct answer: C. Deferasirox (oral once daily)
Explanation
Deferasirox (oral, once-daily) is the preferred chelation agent for transfusion-dependent iron overload in most centres due to convenient dosing, proven efficacy in reducing LIC and cardiac iron (EPIC, ESCALATOR trials), and widespread approval. Deferoxamine is effective but requires 8–12-hour subcutaneous infusion 5–7 nights/week, limiting compliance. Deferiprone (three times daily) is particularly effective for cardiac iron and may be combined with deferasirox for severe myocardial iron. Phlebotomy is contraindicated in transfusion-dependent thalassemia.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.