For healthcare professionals outside the U.S.
Print Text Size

Thalassemia: Monitoring Iron Levels

Assessing the effect of iron chelation therapy by monitoring iron levels is necessary to optimize therapy.1

Methods for Monitoring Iron Levels

Iron levels can be monitored by measuring serum ferritin and liver iron concentration (LIC), or by cardiac magnetic resonance imaging (cardiac MRI) (for cardiac iron concentration) (Table). Establishing effective iron chelation therapy requires careful monitoring and assessment of iron overload, tailored to the individual patient's specific needs.1

Table. Monitoring iron overload.1

  • Serum ferritin
  • Liver iron concentration (LIC)
    • Liver biopsy
    • SQUID
    • Liver MRI
  • Cardiac magnetic resonance imaging (cardiac MRI)

Monitoring Serum Ferritin

Serum ferritin generally correlates with body iron stores and is prognostically relevant in β-thalassemia major. Serum ferritin levels < 2,500 μg/L are associated with a significantly (p < 0.001) lower risk of cardiac disease and death, and the target serum ferritin level is 1,000 μg/L.2,3 Serum ferritin should be monitored at least every 3 months.1-4

In addition to measuring serum ferritin trends, other measures, such as LIC and cardiac MRI, could be considered to monitor iron chelation therapy.1

Measuring Iron

Measuring Iron Levels

Accurate assessment of body iron levels is essential for guiding therapy in patients with chronic anemias who receive regular transfusions.

Learn more >

Measuring Liver Iron Concentration (LIC)

LIC is the reference standard for estimating body iron loading.4 Long-term control of total body iron is an important treatment goal. LIC can be measured invasively by liver biopsy or non-invasively by SQUID or liver MRI. Measurements should be done once a year.1,5

Assessment of LIC should also be considered when serum ferritin trends deviate from expected (e.g. quick substantial reductions). This may reduce the risk of inadequate or excessive doses of iron chelation therapy.1

Estimating Cardiac Iron Using Cardiac MRI

LIC does not always correlate with cardiac iron stores. Thus, when determining the risk of heart complications, measuring cardiac iron is important. Cardiac MRI should be performed once a year.1,5

Estimation of myocardial iron using MRI is becoming increasingly available, but requires considerable expertise and standardization. The gradient-echo T2* method can be used to detect iron overload:
values < 20 ms indicate increased myocardial iron and are associated with an increased chance of decreased left-ventricular function and development of arrhythmia, while T2* values < 10 ms are associated with the development of heart failure.1,6,7

Learn more about diagnostic tools for measuring iron >


  1. Cappellini M-D, Cohen A, Eleftheriou A, et al. Guidelines for the Clinical Management of Thalassaemia. 2nd rev ed. Nicosia, Cyprus: Thalassaemia International Federation; 2008.
  2. Borgna-Pignatti C, et al. Haematologica. 2004;89:1187-93.
  3. Olivieri NF, et al. N Engl J Med. 1994;331:574-8.
  4. United Kingdom Thalassaemia Society. Standards for the clinical care of children and adults with thalassaemia in the UK. 2nd ed. 2008. Accessed February 5, 2014.
  5. Angelucci E, et al. Haematologica. 2008;93:741-52.
  6. Anderson LJ, et al. Eur Heart J. 2001;22:2171-9.
  7. Kirk P, et al. Circulation. 2009;120:1961-8.

Send to a Colleague

Your privacy is important. We will not retain any of the information you enter on this page. Learn more about our privacy policy.

All fields are required.

Your name:
Your colleague's name:
Your colleague's e-mail address:


You are now leaving the website by opening an external website independently operated and not managed by Novartis. Novartis assumes no responsibility for the site you are about to visit. If you do not wish to leave this site, click "Cancel." Otherwise, click "Continue".