An inevitable complication of regular blood transfusions in a Thalassemia major is iron overload. Assessment of iron overload by serum ferritin is widely used, relatively easy to perform and most acceptable, but it fluctuates with infection and inflammation. Therefore, serial measurements and trend of serum ferritin values should be considered.
Assessment of liver iron concentration (LIC) by liver biopsy is invasive and cannot be performed repeatedly.
Superconducting Quantum Interference Device (SQUID) measures LIC accurately. There are only few SQUID machines available worldwide as it is an expensive equipment to purchase and maintain.
Recently, magnetic resonance imaging (MRI) using T2* and R2* relaxation parameters has been used to quantitatively assess iron overload in liver and heart. Cardiac T2* value <20 milliseconds and liver T2* value< 6.3 milliseconds indicate iron overload.