hematology and oncology
Secondary Iron Overload
Treatment of Secondary Iron Overload
Usually iron chelation withdeferasiroxordeferoxamine, or sometimesdeferiprone Some patients can be treated with phlebotomy and given erythropoietin to maintain erythropoiesis. However, because it worsens anemia, phlebotomy is not recommended for many patients (eg, those with hemoglobin level<10 g/dL [< 100 g/L], those who are transfusion dependent, and those who develop symptoms of anemia after phlebotomy). Treatment in these patients is iron chelation. The goal of treatment is a transferrin saturation of<50%. Deferoxamineis the drug traditionally used for iron chelation therapy. Dose is 40 to 50 mg/kg/day (maximum: 60 mg/kg/day) given by a slow subcutaneous infusion overnight over 8 to 12 hours through a portable pump for 5 to 7 nights/week. Dose for children > 3 years and growing adolescents is 20 to 40 mg/kg/day IV infusion over 8 to 12 hours, 5 to 7 days per week, usual maximum daily dose is 40 mg/kg/day. However, this therapy is complex to administer and requires an unusual time commitment from patients, resulting in a high rate of nonadherence. Important adverse effects include hypotension, gastrointestinal disturbances, and anaphylaxis (acutely) and vision and hearing loss (with chronic use). Deferasirox,an oral chelating agent, is an effective and increasingly used alternative todeferoxamine.Deferasiroxreduces iron levels and prevents or delays onset of complications of iron overload. Initial dose is 20 mg/kg orally once a day. Patients are monitored monthly with dose increases up to 30 mg/kg once a day if needed. Maximum dose is 40 mg/kg/day. Ifdeferasiroxoral granules are used, the initial dose is 14 mg/kg/day and the maximum dose is 28 mg/kg/day. Treatment can be interrupted when serum ferritin is<500 ng/mL (< 500 mcg/L). Adverse effects (which occur in about 10% of patients) can include nausea, abdominal pain, diarrhea, and rash. Liver and kidney function may become abnormal; liver and kidney blood tests should be done periodically (eg, monthly, sometimes more frequently for high-risk patients). another oral iron chelator, is indicated for the treatment of patients with transfusional iron overload due to Thalassemias when chelation therapy with Diabetes Mellitus (DM) , Patients should follow a balanced diet; it is not necessary to restrict consumption of iron-containing foods (eg, red meat, liver). Alcohol should be consumed only in moderation because it can increase iron absorption and, in high amounts, increases the risk of cirrhosis. Vitamin C supplements should be avoided because they increase the absorption of iron in the duodenum. 