Severe hypocalcemia-induced ventricular tachycardia in transfusion-dependent β-thalassemia: An uncommon endocrine emergency

Abstract Hypocalcemia is a recognized but underappreciated complication in transfusion-dependent β-thalassemia (TDT), particularly when compounded by hypoparathyroidism. We report a case of a 24-year-old male with TDT who presented with polymorphic ventricular tachycardia secondary to severe hypocalcemia in the setting of hypoparathyroidism. This case emphasizes the endocrine–cardiac interplay and highlights the importance of vigilance for calcium-phosphate disturbances in thalassemia, particularly when iron overload and parathyroid dysfunction coexist. The patient had a total serum calcium of 2.3 mg/dL, magnesium of 0.8 mg/dL, QTc prolongation, and a reduced left ventricular ejection fraction (35%), all of which contributed to a life-threatening arrhythmic presentation. Timely electrolyte correction led to resolution of arrhythmia. This case underscores the necessity of early identification and management of endocrine complications in thalassemia to prevent potentially fatal outcomes.