Diagnostics

Transfusion Therapy and Iron Overload

Regular blood transfusions are a key management approach for a range of chronic anemias such as:

  • β-thalassemia major
  • Sickle cell disease (SCD)
  • Myelodysplastic syndromes (MDS)

However, as the human body has no mechanism to actively excrete excess iron released through the breakdown of transfused red blood cells, repeated transfusions lead to elevated iron levels.

Consequences of Iron Overload

Ongoing iron loading results in:

  • Liver disease
  • Cardiac disease
  • Diabetes mellitus
  • Other complications

These consequences have a significant impact on patient morbidity and can result in premature death if untreated.

Importance of Measuring Iron Levels

Continuing and accurate assessment of body iron levels is therefore essential to guide therapy and ensure optimal patient management.

Methods for Assessing Iron Levels

Iron levels in the body can be assessed by a variety of methods (Table), and thresholds have been described for each of the measurements. Above these thresholds, higher levels of morbidity and mortality can be anticipated.

Table. Methods to assess iron overload

  • Measure serum ferritin (SF)
  • Measure transferrin saturation (TS)
  • Measure labile plasma iron (LPI)
  • Measure non-transferrin-bound iron (NTBI)
  • Measure liver iron concentration (LIC)
    • Biopsy
    • Superconducting quantum interference device (SQUID)
    • Magnetic resonance imaging (MRI)
  • Cardiac MRI
Read about measuring serum ferritin >

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