How is iron overload managed?
Iron chelation therapy is central to mitigating the effects of iron overload
Iron chelation therapy is intended to maintain iron balance in patients who do not have significant iron overload yet but have an on-going source of iron loading, or to reduce iron to safe levels in patients with clinically significant iron overload.1 For transfused patients, iron chelation therapy is considered as soon as transfusion therapy has resulted in sufficient iron accumulation to cause tissue damage; current recommendations are to initiate iron chelation therapy as soon as patients have received around 20 transfusions (10-20 in TDT, 20 in SCD, and up to 25 in MDS) or reached serum ferritin levels > 1,000 μg/L.1-5
In non-transfusion dependent thalassemia (NTDT) patients, iron chelation is recommended in patients who are 10 years or older when iron overload reaches clinically significant levels (serum ferritin > 800 μg/L or liver iron concentration >5 mg Fe/g dry weight).6
Establishing effective iron chelation therapy requires careful monitoring and assessment of iron overload, tailored to the individual patient's specific needs.1
- Cappellini MD, Cohen A, Porter J, et al. Guidelines for the management of transfusion dependent thalassemia (TDT). 3rd Ed. Nicosia, Cyprus: Thalassemia International Federation; 2014.
- Standards for the clinical care of adults with Sickle Cell Disease in the UK. London, UK: The Sickle Cell Society; 2008.
- Bennett JM, MDS Foundation's Working Group on Transfusional Iron Overload. Consensus statement on iron overload in myelodysplastic syndromes. Am J Hematol. 2008;83(11):858-861.
- Malcovati L, Hellstrom-Lindberg E, Bowen D, et al. Diagnosis and treatment of primary myelodysplastic syndromes in adults: recommendations from the European LeukemiaNet. Blood. 2013;122(17):2943-2964.
- de Montalembert M, Ferster A, Colombatti R, et al. ENERCA clinical recommendations for disease management and prevention of complications of sickle cell disease in children. Am J Hematol. 2011;86(1):72-75.
- Taher A, Vichinsky E, Cappellini MD, et al. Guidelines for the management of non-transfusion dependent thalassemia (NTDT). Nicosia, Cyprus: Thalassemia International Federation; 2013.