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Why does the liver enlarge in thalassemia?
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The enlargement of Liver happens due to continuous transfusions without adequate chelation.
If there is no chelation at all it will enlarge quickly and vice versa. So, Hepatomegaly does happen in Thalassemia because Liver stores the excess iron which remains in the body due to inadequate chelation. Is the case of thalassemia, organs are expanding due to the dual effects of low hemoglobin in the body. In some cases, the bone marrow can produce some amount of misshaped RBCs.
The Spleen then becomes hyperactive to get rid of these cells, which in turn leads to the bone marrow trying to work some more - in effect, a vicious cycle develops where the spleen will get enlarged and the bone marrow will expand, weakening the bones. The only key to Success over Thalassemia is Adequate Transfusion with Adequate Chelation without worrying about future.