In beta-thalassemia major, ineffective erythropoiesis leads to all of the following EXCEPT:

• A Decreased hepcidin leading to iron deficiency ✓
• B Expansion of erythroid marrow into cortical bone causing frontal bossing
• C Hemosiderosis from increased intestinal iron absorption
• D Splenomegaly from extramedullary hematopoiesis

Explanation

In beta-thalassemia major, massive ineffective erythropoiesis suppresses hepcidin (via erythroferrone from erythroblasts), which paradoxically increases intestinal iron absorption and causes iron overload (hemosiderosis), not iron deficiency. Erythroid expansion, extramedullary hematopoiesis causing splenomegaly, and bony deformities are all consequences of ineffective erythropoiesis.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

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