This handout is for thalassaemia (tdt / ntdt / α-thal-hbh / trait — chronic management). Your care team identified this based on: microcytic hypochromic anaemia on cbc — discriminate thalassaemia trait vs ida (tif 5th ed 2025 pmid 40045934).
Other reasons your team may use this plan: known thalassaemia on problem list — comprehensive clinic visit (tif 5th ed 2025); abnormal hb electrophoresis/hplc (↑hba2 / ↑hbf / hbh / hbe) (tif 5th ed 2025); positive antenatal/newborn carrier screen → genetic counselling (tif 5th ed 2025).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| deferasirox | 14 mg/kg/day (film-coated tablet); titrate 7–28 mg/kg | PO | once daily | First-line PO chelator; titrate by ferritin/LIC trend. Boxed warning: renal/hepatic failure, GI haemorrhage — monitor eGFR + LFT + GI symptoms (TIF 5th ed 2025 PMID 40045934) |
| deferoxamine | 20–40 mg/kg/day SC over 8–12 h; up to 50–60 mg/kg/day IV (intensive) for siderotic cardiomyopathy | SC | 5–7 nights/week (continuous IV if cardiac decompensation) | Pregnancy-preferred chelator; 24-h IV for iron cardiomyopathy; backbone of DFP+DFO combination (Tanner Circulation 2007 PMID 17372174) |
| deferiprone | 75 mg/kg/day divided TID (up to 99 mg/kg/day) | PO | three times daily | Superior myocardial iron clearance; combination with deferoxamine for cardiac T2* <10 ms (Tanner PMID 17372174). MANDATORY weekly ANC — agranulocytosis ~1–2% (TIF 5th ed 2025) |
| folic acid | 5 mg | PO | once daily | Supports increased erythropoietic folate demand in chronic haemolysis / ineffective erythropoiesis (TIF NTDT 2023 NBK599489) |
Plan: Iron chelation (compartment- and cardiac-T2*-directed)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Annual endocrinopathy screen — hypogonadism, growth failure, diabetes, hypothyroidism, hypoparathyroidism, osteoporosis (bone densitometry; calcium + vitamin D); cardiac + hepatic surveillance (HCC screening if cirrhotic — route gi.cirrhosis.core.v1); fertility / pregnancy planning + pre-conception chelation washout; vaccination + lifelong penicillin if splenectomised; transition pediatric→adult care; partner + family genetic counselling, prenatal/PGT options (TIF 5th ed 2025; NTDT 2023 NBK599489)
Guideline: TIF Guidelines for the Management of Transfusion-Dependent β-Thalassaemia, 5th edition 2025 (Musallam/Taher HemaSphere, PMID 40045934) + TIF NTDT 3rd edition 2023 (NBK599489) + BELIEVE/BEYOND luspatercept + beti-cel HGB-207/212 + exa-cel CLIMB THAL-111 + cardiac-T2* (Kirk/Pennell) + combined chelation (Tanner)