A 19-year-old woman with thalassaemia major on regular transfusions has serum ferritin of 3800 ng/mL and hepatic iron concentration of 9 mg/g dry weight on MRI T2* (normal <1.8). She has poor compliance with deferoxamine injections. Which oral iron chelator is first-line for this level of iron overload?
- A Deferiprone
- B Deferasirox ✓
- C Deferoxamine oral formulation
- D Phlebotomy
Correct answer: B. Deferasirox
Explanation
Deferasirox (Exjade/Jadenu) is an oral tridentate iron chelator approved as first-line oral therapy for transfusional iron overload. It is given once daily, improving compliance compared to deferoxamine (subcutaneous infusion 8–12 hours/day, 5–7 days/week). Deferiprone (Ferriprox) is particularly effective at removing cardiac iron and is used in combination or as an alternative, but not first-line for hepatic overload. Phlebotomy is inappropriate in thalassaemia major with chronic anaemia requiring transfusions.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.