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Iron overload after repeated blood transfusions is a serious complication that occurs when excess iron gradually accumulates in the body. It commonly affects people who require long-term transfusion support for conditions such as thalassaemia, myelodysplastic syndromes, aplastic anaemia, and certain chronic anaemias. Each unit of packed red blood cells contains substantial iron, while the body has limited natural mechanisms for removing it.

Initially, excess iron is stored in the liver, but progressive accumulation can affect the heart, pancreas, endocrine glands, and other organs. Patients may remain symptom-free for years before complications develop. With increasing iron deposition, fatigue, abdominal discomfort, abnormal liver function, diabetes, delayed growth or puberty, and cardiac problems may occur. Severe cardiac iron overload can lead to arrhythmias or heart failure.

Diagnosis involves monitoring serum ferritin and transfusion history, although ferritin alone may not accurately reflect total iron burden. Liver and cardiac iron can be assessed using specialised magnetic resonance imaging techniques. Management focuses on iron chelation therapy, using medicines that bind excess iron and promote its elimination. Regular monitoring helps assess treatment effectiveness and organ health.

Preventing unnecessary transfusions and maintaining appropriate chelation adherence are important. Early recognition and consistent management can reduce organ damage, improve quality of life, and lower the risk of long-term complications associated with transfusional iron overload.