Iron-Chelating Therapy for Transfusional Iron Overload

Abstract

A 16-year-old boy with sickle cell anemia undergoes routine screening with transcranial Doppler ultrasonography to assess the risk of stroke. This examination shows an abnormally elevated blood-flow velocity in the middle cerebral artery. The hemoglobin level is 7.2 g per deciliter, the reticulocyte count is 12.5%, and the fetal hemoglobin level is 8.0%. Long-term treatment with red-cell transfusion is initiated to prevent stroke. A hematologist recommends prophylactic iron-chelating therapy.

Management of Anemia in Cancer Patients: Transfusions

“…Continued transfusion therapy in the absence of iron chelation can lead to fatal liver or heart dysfunction. Oral iron chelators can be used in patients with hematological malignancies in need of long-term transfusion treatment [20].…”

The role of endocytic pathways in cellular uptake of plasma non-transferrin iron

“…6 Persistently high plasma NTBI levels can lead to uncontrolled ingress of labile iron into cells and ensuing tissue damage in organs such as liver, endocrine glands and heart. 3,[6][7][8] These properties have led NTBI to be considered an indicator of impending tissue iron overload and a target of chelation therapy. 3,5,9 However, the identification of membrane-permeant iron species in plasma NTBI and their routes of ingress into particular cells have not been established, largely because of the heterogeneic nature of NTBI itself and its variable composition in different pathologies.…”

A case of hypophosphatemic osteomalacia secondary to deferasirox therapy

“…(5) DFO has been the standard iron chelating agent used for the past 4 decades but requires parenteral administration. Deferiprone and deferasirox are orally active iron chelators and are being increasingly used in those with transfusion dependent thalassemia major.…”