Secondary iron overload

• Published in: Hematology Vol. 2001; no. 1; pp. 47 - 61
• Main Authors: Kushner, J P, Porter, J P, Olivieri, N F
• Format: Journal Article
• Language: English
• Published: United States 2001
• Subjects: Anemia, Sickle Cell - complications; Clinical Trials as Topic; Humans; Iron Chelating Agents - pharmacokinetics; Iron Chelating Agents - therapeutic use; Iron Chelating Agents - toxicity; Iron Overload - drug therapy; Iron Overload - etiology; Practice Guidelines as Topic; Thalassemia - complications; Transfusion Reaction
• ISSN: 1520-4391; 1520-4383
• DOI: 10.1182/asheducation-2001.1.47

Transfusion therapy for inherited anemias and acquired refractory anemias both improves the quality of life and prolongs survival. A consequence of chronic transfusion therapy is secondary iron overload, which adversely affects the function of the heart, the liver and other organs. This session will review the use of iron chelating agents in the management of transfusion-induced secondary iron overload. In Section I Dr. John Porter describes techniques for the administration of deferoxamine that exploit the pharmacokinetic properties of the drug and minimize potential toxic side effects. The experience with chelation therapy in patients with thalassemia and sickle cell disease will be reviewed and guidelines will be suggested for chelation therapy of chronically transfused adults with refractory anemias. In Section II Dr. Nancy Olivieri examines the clinical consequences of transfusion-induced secondary iron overload and suggests criteria useful in determining the optimal timing of the initiation of chelation therapy. Finally, Dr. Olivieri discusses the clinical trials evaluating orally administered iron chelators.