Clinical Characteristics and Differential Treatment Outcomes in Warm versus Cold Pediatric Autoimmune Hemolytic Anemia
Year: 2026
Type: article
Study design: Observational Study
Abstract: transfusion-dependent thalassaemia.However, poor compliance results in persistent cardiac and hepatic iron overload.We evaluated the role of cardiac T2* MRI in assessing tissue iron burden.Methods: We conducted a retrospective study at the VHS Thalassaemia Centre, Chennai, India, between January 2019 and June 2026, including all patients above 12 years of age with TDT.Demographic data, serial serum ferritin, and iron chelation details were collected.Patients underwent cardiac T2* MRI and liver iron concentration (LIC) assessment every two years using a 0.5-Tesla MRI scanner.Cardiac iron overload was defined as T2* <20 ms and liver iron overload as LIC >7.5 mg/g dry liver weight.MRI findings were discussed with patients and their families.All patients received film-coated oral deferasirox four days weekly and were advised subcutaneous deferoxamine (40 mg/kg/day) at least three days weekly.Used deferoxamine vials were exchanged for new ones to encourage compliance.Results: Eighty-five patients (male ratio 1:1) underwent cardiac T2* MRI during the study period.MRI demonstrated cardiac and/or liver iron overload in 42/85 (49.4%) patients.The majority had liver iron overload, while a smaller proportion had cardiac involvement.Five patients (5.8%) died during follow-up, all of whom had combined cardiac and liver iron overload.MRI findings enabled better counselling regarding tissue iron burden and reinforced the need for intensified chelation.Despite structured follow-up and combination chelation, nearly half of the cohort continued to have significant tissue iron overload.Conclusion: Nearly half of adolescents and adults with TDT had persistent tissue iron overload despite aggressive chelation.Cardiac T2* MRI is a valuable tool for identifying patients at risk, guiding chelation, and improving patient understanding and adherence.Early serial MRI assessment from eight years of age, together with multidisciplinary care and patient education, may reduce irreversible organ damage and ironrelated mortality.
Language: English
Subfield: Genetics (clinical)
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $600
OpenAlex ID: W7220852162