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In patients with untreated beta thalassemia, the expansion of bone marrow occurs as a compensatory mechanism due to chronic hemolytic anemia. The bone marrow attempts to produce more red blood cells to counteract the ineffective erythropoiesis and the destruction of red blood cells. This expansion can lead to a number of skeletal abnormalities, one of which is malocclusion of teeth.

As the marrow expands, it causes changes in the facial bones and the dental arch, which can affect the alignment and position of the teeth, leading to malocclusion. This is a common clinical manifestation in individuals with significant marrow expansion due to the chronic nature of their disease. Therefore, malocclusion of teeth is a direct consequence of the skeletal changes associated with the expansion of bone marrow in untreated beta thalassemia patients.

The other options do not accurately reflect the impacts of bone marrow expansion in this context. Increased energy levels may not be seen due to ongoing anemia, while the risk of infections is typically increased due to complications from the disease and its treatment. Similarly, an enhanced immune response is not a consequence of marrow expansion in this condition.