The cornerstones of modern treatment in β thalassaemia are blood transfusion and iron chelation therapy.5
Multiple transfusions cause iron overload resulting in hepatic, cardiac and endocrine dysfunction. The anterior
pituitary is very sensitive to iron overload and evidence of dysfunction is common.6 Puberty is often delayed
and incomplete, resulting in low bone mass.7 Most of these women are subfertile due to hypogonadotrophic
hypogonadism and therefore require ovulation induction therapy with gonadotrophins to achieve a
pregnancy.8–10 Cardiac failure is the primary cause of death in over 50% of cases.11 Improved transfusion
techniques and effective chelation protocols have improved the quality of life and survival of individuals with
thalassaemia.12,13 The mortality from cardiac iron overload has reduced significantly since the development of
magnetic resonance imaging (MRI) methods for monitoring cardiac (cardiac T2*) and hepatic iron overload
(liver T2*) and FerriScan® liver iron assessment (FerriScan®, Resonance Health, Australia). These methods are
now available in most large centres looking after patients with haemoglobinopathies.