Thalassemia is a genetic blood disorder causing chronic anemia. The primary treatment for severe forms is frequent blood transfusions. A major, life-threatening complication of chronic transfusion therapy is iron overload (hemosiderosis), as the body cannot naturally excrete the excess iron from transfused red blood cells. This iron accumulates in and damages vital organs like the heart, liver, and endocrine glands. Therefore, it is critical for the patient and family to be educated on the signs and symptoms of iron overload (e.g., fatigue, joint pain, arrhythmias, abdominal pain) to ensure early detection and adherence to chelation therapy, which removes excess iron from the body.

A. Iron supplementation is contraindicated because it would exacerbate the iron overload that already results from hemolysis and frequent blood transfusions.

B. While cardiac complications can occur from iron overload, routine weekly blood pressure monitoring is not a primary, specific discharge instruction for thalassemia.

D. Patients are encouraged to participate in physical activity as tolerated to promote well-being; a blanket restriction on exercise is inappropriate.

1. Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2019). Wong's nursing care of infants and children (11th ed.). Elsevier. In Chapter 29, "The Child with Hematologic or Immunologic Dysfunction," the section on Thalassemia Major (Cooley Anemia) discusses the therapeutic management, stating, "A complication of the repeated transfusions is hemosiderosis... To prevent organ damage from iron overload, chelation therapy... is begun." This underscores the importance of managing and monitoring for iron overload.

2. National Heart, Lung, and Blood Institute (NHLBI). (2022, March 24). Thalassemia - Treatment. U.S. Department of Health & Human Services. In the section "Iron Chelation Therapy," it is stated, "Blood transfusions can lead to a buildup of iron in the blood (iron overload). This condition can damage the liver, heart, and other parts of the body... your doctor may prescribe iron chelation therapy to remove excess iron from your body." This highlights iron overload as a direct consequence of treatment requiring management and patient awareness.

3. Angelucci, E., & Barosi, G. (2013). Management of iron overload in thalassemia and other congenital anemias. In A. V. Hoffbrand & D. G. Higgs (Eds.), Postgraduate Haematology (7th ed., pp. 127-141). Wiley-Blackwell. Chapter 9 details the pathophysiology of transfusional iron overload and emphasizes patient education for adherence to chelation therapy as a cornerstone of management to prevent organ toxicity.