Schematic summary of factors that may contribute to TBD and their management
| Factor . | Key mechanism . | Treatment . | Prevention . |
|---|---|---|---|
| Bone marrow expansion | Ineffective erythropoiesis | Transfusion at optimal Hb levels | Transfusion at optimal Hb levels |
| Iron overload | Iron toxicity | Optimal iron chelation | Early and regular iron chelation |
| Iron chelation | Overchelation; drug toxicity | Tune chelation intensity on iron overload; avoid high doses | Tune chelation intensity on iron overload |
| Hypogonadism | Iron toxicity | Replacement therapy | Early and regular iron chelation |
| Hypoparathyroidism | Iron toxicity | Replacement therapy | Early and regular iron chelation |
| Hyperparathyroidism | Vitamin D deficiency | Vitamin D2 or D3 | Vitamin D2 or D3 |
| Hypothyroidism | Iron toxicity | Replacement therapy | Early and regular iron chelation |
| GH | Iron toxicity | Replacement therapy | Early and regular iron chelation |
| Diabetes | Iron toxicity | Replacement therapy | Regular iron chelation; lifestyle |
| Liver disease | Viral hepatitis; iron toxicity | Antiviral therapy; regular iron chelation | Safe blood; regular iron chelation |
| Vitamin D deficiency | Iron toxicity | Vitamin D2 or D3 | ? |
| Renal disease | Hypercalciuria | Correct causes | ? |
| Vitamin C deficiency | Iron toxicity | Vitamin C–rich diet | Optimal iron chelation |
| Factor . | Key mechanism . | Treatment . | Prevention . |
|---|---|---|---|
| Bone marrow expansion | Ineffective erythropoiesis | Transfusion at optimal Hb levels | Transfusion at optimal Hb levels |
| Iron overload | Iron toxicity | Optimal iron chelation | Early and regular iron chelation |
| Iron chelation | Overchelation; drug toxicity | Tune chelation intensity on iron overload; avoid high doses | Tune chelation intensity on iron overload |
| Hypogonadism | Iron toxicity | Replacement therapy | Early and regular iron chelation |
| Hypoparathyroidism | Iron toxicity | Replacement therapy | Early and regular iron chelation |
| Hyperparathyroidism | Vitamin D deficiency | Vitamin D2 or D3 | Vitamin D2 or D3 |
| Hypothyroidism | Iron toxicity | Replacement therapy | Early and regular iron chelation |
| GH | Iron toxicity | Replacement therapy | Early and regular iron chelation |
| Diabetes | Iron toxicity | Replacement therapy | Regular iron chelation; lifestyle |
| Liver disease | Viral hepatitis; iron toxicity | Antiviral therapy; regular iron chelation | Safe blood; regular iron chelation |
| Vitamin D deficiency | Iron toxicity | Vitamin D2 or D3 | ? |
| Renal disease | Hypercalciuria | Correct causes | ? |
| Vitamin C deficiency | Iron toxicity | Vitamin C–rich diet | Optimal iron chelation |
Hb, hemoglobin TBD, thalassemia bone disease.