Imaging studies:
The classic appearance of
the skull, which results from widening of the diploic spaces, is observed on
plain radiographs. Maxilla may overgrow, which results in maxillary overbite,
prominence of the upper incisors, and separation of the orbits. These changes
contribute to the classic "chipmunk facies" observed in patients with
thalassemia major (Atichartakarn et al., 2003).
Compression fractures and
paravertebral expansion of extramedullary masses, which could behave clinically
like tumors, more frequently occur during the second decade of life. MRI and CT
scanning are usually used in diagnosing such complications and can be used as
noninvasive means to evaluate the amount of iron in the liver in patients
receiving chelation therapy (Fucharoen et al., 2000).
Hepatic iron concentration
by liver biopsy:
It is considered the most
accurrate and sensetive method for determining the body iron burden. However,
this is an invasive technique with a low but recognized complication rate; the
result is affected by hepatic fibrosis (especially in small biopsy) which is
common in thalassemia as a result of increased liver iron and HCV infection;
and the iron has been shown to be unevenly distributed in the thalassemic liver
even in the non cirrhotic stages (Cohen et al., 2004).
Other Tests:
·
ECG and
echocardiography are performed to monitor cardiac function.
·
HLA typing is
performed for patients for whom bone marrow transplantation is considered.
·
Eye examination.
·
Hearing tests.
·
Renal function tests are required to monitor
desferroxamine therapy.
·
Routine endocrine
tests.
·
Screening for hepatic
dysfunction (Honig, 2000).
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