Looking after your liver

The two main causes of liver problems in thalassaemia are iron overload and viral hepatitis. The liver stores most of the body’s excess iron, so over years uncontrolled iron can cause scarring — fibrosis, then cirrhosis. LIC is monitored (by MRI) and chelation adjusted to keep it in range; a ferritin persistently above ~2,000 suggests rising liver iron.

Some patients carry hepatitis B or C from transfusions received before modern screening. The great news: hepatitis C is now usually curable with a short course of modern antiviral tablets, and effective treatments exist for hepatitis B — so viral status is checked and treated when needed. Everyone with thalassaemia should be vaccinated against hepatitis B.

Because scarring and viral hepatitis raise the risk of liver cancer (hepatocellular carcinoma), people with high liver iron (LIC around 7 mg/g or more) or cirrhosis are offered regular liver-cancer surveillance — usually a liver ultrasound and an alpha-fetoprotein (AFP) blood test. Good iron control is itself an important way to lower this risk.

Protect your liver: keep chelation on track, stay up to date with hepatitis B vaccination, and avoid excess alcohol.