Oxidative damage and genotoxicity biomarkers in transfused and untransfused thalassemic subjects

► In β-thalassemias redox-active iron causes free radical overproduction. ► Despite the lower iron level, in untransfused patients reactive oxygen species (ROS) concentrations are higher. ► Hypoxia contributes to the redox imbalance in addition to iron overload. ► Hypoxia causes mitochondrial impairment and increases endogenous ROS generation. ► Reticulocytes, a hypoxia-induced erythropoiesis marker, correlate with genotoxicity.