Assessing the effect of iron chelation therapy by monitoring iron levels is necessary to optimize therapy.
Iron levels can be monitored by measuring serum ferritin and liver iron concentration (LIC), or by cardiac magnetic resonance imaging (cardiac MRI) (for cardiac iron concentration) (Table). Establishing effective iron chelation therapy requires careful monitoring and assessment of iron overload, tailored to the individual patient's specific needs.1
Serum ferritin generally correlates with body iron stores and is prognostically relevant in
In addition to measuring serum ferritin trends, other measures, such as LIC and cardiac MRI, could be considered to monitor iron chelation therapy.
Accurate assessment of body iron levels is essential for guiding therapy in patients with chronic anemias who receive regular transfusions.Learn more >
LIC is the reference standard for estimating body iron loading.4 Long-term control of total body iron is an important treatment goal. LIC can be measured invasively by liver biopsy or non-invasively by SQUID or liver MRI. Measurements should be done once a year.
Assessment of LIC should also be considered when serum ferritin trends deviate from expected (e.g. quick substantial reductions). This may reduce the risk of inadequate or excessive doses of iron chelation therapy.
LIC does not always correlate with cardiac iron stores. Thus, when determining the risk of heart complications, measuring cardiac iron is important. Cardiac MRI should be performed once a year.
Estimation of myocardial iron using MRI is becoming increasingly available, but requires considerable expertise and standardization. The gradient-echo T2* method can be used to detect iron overload:
values < 20 ms indicate increased myocardial iron and are associated with an increased chance of decreased left-ventricular function5 and development of arrhythmia, while T2* values < 10 ms are associated with the development of heart failure.6
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