Medscape is available in 5 Language Editions – Choose your Edition here.


Transfusion-Induced Iron Overload Follow-up

  • Author: Muhammad A Mir, MD, FACP; Chief Editor: Emmanuel C Besa, MD  more...
Updated: Mar 10, 2014

Further Inpatient Care

Hospital admissions in cases of transfusion-induced iron overload may result from complications of cirrhosis, sepsis, and heart failure, amongst other causes, and should be managed with a multidisciplinary team approach.



Compliance with chelation therapy for transfusion-induced iron overload is specific to the treatment center, with better long-term survival in centers that have experience in chelation management than in centers where small numbers of patients are treated.[114]



All patients who are transfusion dependent require careful monitoring of their iron stores. It is advisable to measure ferritin levels at least every 3 months and iron studies every year. Liver iron levels should be measured annually (either by biopsy or noninvasively) and every 3–6 months in patients who undergo intensive chelation for heart failure. If MRI is available, cardiac iron levels and cardiac function should also be measured by MRI yearly and every 6 months in patients who have intensive chelation therapy.[46]



Monitoring liver function test results and kidney function, especially in sickle cell patients, is recommended during chelation therapy.



Complications of iron overload have been steadily falling since the introduction of deferoxamine. For thalassemia major patients in Italy who were started on deferoxamine after subcutaneous infusions became widely available in 1980, death from cardiac disease fell from 5% at 20 years to 1%, and the incidence rates hypogonadism, diabetes, and hypothyroidism also fell significantly.

Better survival has been demonstrated for patients born in more recent years (P < 0.00005) and for females (P = 0.0003). In a study by Borgna-Pignatti et al, 68% of patients were alive at age 35 years, with 67% of the patient deaths due to heart disease.[77] In some patients treated with deferoxamine (particularly those who start treatment late or who fail to comply with treatment), high levels of iron (>15 mg iron per gram of liver dry weight) are still present—a level that is associated with a high risk of cardiac disease and early death over a long period.[89] Failure to control serum ferritin over prolonged periods is also associated with an increased risk of cardiac disease and death.[14]


Patient Education

Compliance is the major limiting factor of chelation therapy in cases of transfusion-induced iron overload, and continuous re-enforcement is needed. Patients should be educated about symptoms of heart failure, cirrhosis, and diabetes.

Contributor Information and Disclosures

Muhammad A Mir, MD, FACP Assistant Professor of Medicine (Hematology, Blood/Marrow Transplant) Milton S Hershey Medical Center, Pennsylvania State University College of Medicine

Muhammad A Mir, MD, FACP is a member of the following medical societies: American College of Physicians, American Society of Hematology, American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology

Disclosure: Nothing to disclose.


Gerald L Logue, MD Professor of Medicine, Head of the Division of Hematology, Vice Chairman for Education, Department of Medicine, University of Buffalo State University of New York School of Medicine and Biomedical Sciences

Gerald L Logue, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American College of Physicians, American Society of Hematology, American Federation for Clinical Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ronald A Sacher, MB, BCh, FRCPC, DTM&H Professor, Internal Medicine and Pathology, Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center

Ronald A Sacher, MB, BCh, FRCPC, DTM&H is a member of the following medical societies: American Association for the Advancement of Science, American Association of Blood Banks, American Society for Clinical Pathology, American Society of Hematology, College of American Pathologists, International Society on Thrombosis and Haemostasis, Royal College of Physicians and Surgeons of Canada, American Clinical and Climatological Association, International Society of Blood Transfusion

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: GSK Pharmaceuticals,Alexion,Johnson & Johnson Talecris,,Grifols<br/>Received honoraria from all the above companies for speaking and teaching.

Chief Editor

Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American Society of Clinical Oncology, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, New York Academy of Sciences

Disclosure: Nothing to disclose.

Additional Contributors

Pradyumna D Phatak, MBBS, MD Chair, Division of Hematology and Medical Oncology, Rochester General Hospital; Clinical Professor of Oncology, Roswell Park Cancer Institute

Pradyumna D Phatak, MBBS, MD is a member of the following medical societies: American Society of Hematology

Disclosure: Received honoraria from Novartis for speaking and teaching.

  1. Anderson GJ. Mechanisms of iron loading and toxicity. Am J Hematol. 2007 Dec. 82(12 suppl):1128-31. [Medline].

  2. Anderson GJ, Vulpe CD. Regulation of intestinal iron transport. Templeton DM, ed. Molecular and Cellular Iron Transport. New York: Marcel Dekker Inc; 2002. 559-96.

  3. Diseases of iron metabolism. The Internet Pathology Laboratory for Medical Education. Available at Accessed: December 16, 2007.

  4. Pietrangelo A. Hereditary hemochromatosis. Biochim Biophys Acta. 2006 Jul. 1763(7):700-10. [Medline].

  5. Anderson GJ, Darshan D, Wilkins SJ, Frazer DM. Regulation of systemic iron homeostasis: how the body responds to changes in iron demand. Biometals. 2007 Jun. 20(3-4):665-74. [Medline].

  6. Anderson GJ. Mechanisms of iron loading and toxicity. Am J Hematol. 2007 Dec. 82(12 suppl):1128-31. [Medline].

  7. Hershko C. Iron loading and its clinical implications. Am J Hematol. 2007 Dec. 82(12 suppl):1147-8. [Medline].

  8. Origa R, Galanello R, Ganz T, et al. Liver iron concentrations and urinary hepcidin in beta-thalassemia. Haematologica. 2007 May. 92(5):583-8. [Medline]. [Full Text].

  9. Kohgo Y, Ohtake T, Ikuta K, et al. Iron accumulation in alcoholic liver diseases. Alcohol Clin Exp Res. 2005 Nov. 29(11 suppl):189S-93S. [Medline].

  10. Esposito BP, Breuer W, Sirankapracha P, et al. Labile plasma iron in iron overload: redox activity and susceptibility to chelation. Blood. 2003 Oct 1. 102(7):2670-7. [Medline]. [Full Text].

  11. Gutteridge JM. Lipid peroxidation and antioxidants as biomarkers of tissue damage. Clin Chem. 1995 Dec. 41(12 pt 2):1819-28. [Medline]. [Full Text].

  12. Ganong WF. Digestion and absorption. Ganong WF, ed. Review of Medical Physiology. 17th ed. East Norwalk, Conn, U: Appleton & Lange; 1995. 441.

  13. Bowen R. Ferritin and hemosiderin. Updated April 7, 2001. Hypertexts for Biomedical Sciences. Available at Accessed: December 23, 2007.

  14. Olivieri NF, Nathan DG, MacMillan JH, et al. Survival in medically treated patients with homozygous beta-thalassemia. N Engl J Med. 1994 Sep 1. 331(9):574-8. [Medline]. [Full Text].

  15. Suarez WA, Snyder SA, Berman BB, Brittenham GM, Patel CR. Preclinical cardiac dysfunction in transfusion-dependent children and young adults detected with low-dose dobutamine stress echocardiography. J Am Soc Echocardiogr. 1998 Oct. 11(10):948-56. [Medline].

  16. Wolfe L, Olivieri N, Sallan D, et al. Prevention of cardiac disease by subcutaneous deferoxamine in patients with thalassemia major. N Engl J Med. 1985 Jun 20. 312(25):1600-3. [Medline].

  17. Huang YC, Chang JS, Wu KH, Peng CT. Regression of myocardial dysfunction after switching from desferrioxamine to deferiprone therapy in beta-thalassemia major patients. Hemoglobin. 2006. 30(2):229-38. [Medline].

  18. Stoyanova E, Cloutier G, Felfly H, Lemsaddek W, Ah-Son N, Trudel M. Evidence for a novel mechanism independent of myocardial iron in ß-thalassemia cardiac pathogenesis. PLoS One. 2012. 7(12):e52128. [Medline].

  19. Aessopos A, Farmakis D. Pulmonary hypertension in beta-thalassemia. Ann N Y Acad Sci. 2005. 1054:342-9. [Medline].

  20. Piatti G, Allegra L, Fasano V, et al. Lung function in beta-thalassemia patients: a longitudinal study. Acta Haematol. 2006. 116(1):25-9. [Medline].

  21. Jean G, Terzoli S, Mauri R, Borghetti L, Di Palma A, Piga A, et al. Cirrhosis associated with multiple transfusions in thalassaemia. Arch Dis Child. 1984 Jan. 59(1):67-70. [Medline]. [Full Text].

  22. Liuzzi JP, Aydemir F, Nam H, Knutson MD, Cousins RJ. Zip14 (Slc39a14) mediates non-transferrin-bound iron uptake into cells. Proc Natl Acad Sci U S A. 2006 Sep 12. 103(37):13612-7. [Medline]. [Full Text].

  23. Moayeri H, Oloomi Z. Prevalence of growth and puberty failure with respect to growth hormone and gonadotropins secretion in beta-thalassemia major. Arch Iran Med. 2006 Oct. 9(4):329-34. [Medline].

  24. Gamberini MR, Fortini M, De Sanctis V, Gilli G, Testa MR. Diabetes mellitus and impaired glucose tolerance in thalassaemia major: incidence, prevalence, risk factors and survival in patients followed in the Ferrara Center. Pediatr Endocrinol Rev. 2004 Dec. 2 suppl 2:285-91. [Medline].

  25. Angelopoulos NG, Zervas A, Livadas S, et al. Reduced insulin secretion in normoglycaemic patients with beta-thalassaemia major. Diabet Med. 2006 Dec. 23(12):1327-31. [Medline].

  26. De Sanctis V, Roos M, Gasser T, et al. Impact of long-term iron chelation therapy on growth and endocrine functions in thalassaemia. J Pediatr Endocrinol Metab. 2006 Apr. 19(4):471-80. [Medline].

  27. Cantinieaux B, Janssens A, Boelaert JR, et al. Ferritin-associated iron induces neutrophil dysfunction in hemosiderosis. J Lab Clin Med. 1999 Apr. 133(4):353-61. [Medline].

  28. Chirio R, Collignon A, Sabbah L, Lestradet H, Torlotin JC. [Yersinia enterocolitica infections and thalassemia major in children] [French]. Ann Pediatr (Paris). 1989 May. 36(5):308; 311-4. [Medline].

  29. Bergmann TK, Vinding K, Hey H. Multiple hepatic abscesses due to Yersinia enterocolitica infection secondary to primary haemochromatosis. Scand J Gastroenterol. 2001 Aug. 36(8):891-5. [Medline].

  30. Chiu HY, Flynn DM, Hoffbrand AV, Politis D. Infection with Yersinia enterocolitica in patients with iron overload. Br Med J (Clin Res Ed). 1986 Jan 11. 292(6513):97. [Medline].

  31. Karimi M, Jamalian N, Rasekhi A, Kashef S. Magnetic resonance imaging (MRI) findings of joints in young beta-thalassemia major patients: fluid surrounding the scaphoid bone: a novel finding, as the possible effect of secondary hemochromatosis. J Pediatr Hematol Oncol. 2007 Jun. 29(6):393-8. [Medline].

  32. Cunningham MJ, Macklin EA, Neufeld EJ, Cohen AR. Complications of beta-thalassemia major in North America. Blood. 2004 Jul 1. 104(1):34-9. [Medline]. [Full Text].

  33. Brittenham GM. Iron-chelating therapy for transfusional iron overload. N Engl J Med. 2011 Jan 13. 364(2):146-56. [Medline]. [Full Text].

  34. Takatoku M, Uchiyama T, Okamoto S, et al. Retrospective nationwide survey of Japanese patients with transfusion-dependent MDS and aplastic anemia highlights the negative impact of iron overload on morbidity/mortality. Eur J Haematol. 2007 Jun. 78(6):487-94. [Medline].

  35. Ladis V, Chouliaras G, Berdousi H, Kanavakis E, Kattamis C. Longitudinal study of survival and causes of death in patients with thalassemia major in Greece. Ann N Y Acad Sci. 2005. 1054:445-50. [Medline].

  36. Fung EB, Harmatz P, Milet M, et al. Morbidity and mortality in chronically transfused subjects with thalassemia and sickle cell disease: A report from the multi-center study of iron overload. Am J Hematol. 2007 Apr. 82(4):255-65. [Medline].

  37. Brown KE, Khan CM, Zimmerman MB, Brunt EM. Hepatic iron overload in blacks and whites: a comparative autopsy study. Am J Gastroenterol. 2003 Jul. 98(7):1594-8. [Medline].

  38. Italian Working Group on Endocrine Complications in Non-endocrine Diseases. Multicentre study on prevalence of endocrine complications in thalassaemia major. Clin Endocrinol (Oxf). 1995 Jun. 42(6):581-6. [Medline].

  39. Milosevic R, Antonijevic N, Jankovic G, Babic D, Colovic M. [Aplastic anemia--clinical characteristics and survival analysis] [Serbian]. Srp Arh Celok Lek. 1998 Jul-Aug. 126(7-8):234-8. [Medline].

  40. Aul C, Gattermann N, Germing U, Runde V, Heyll A. [Myelodysplastic syndromes. The epidemiological and etiological aspects] [German]. Dtsch Med Wochenschr. 1992 Aug 14. 117(33):1223-31. [Medline].

  41. Hassan M, Hasan S, Giday S, et al. Hepatitis C virus in sickle cell disease. J Natl Med Assoc. 2003 Oct. 95(10):939-42. [Medline].

  42. Halonen P, Mattila J, Suominen P, et al. Iron overload in children who are treated for acute lymphoblastic leukemia estimated by liver siderosis and serum iron parameters. Pediatrics. 2003 Jan. 111(1):91-6. [Medline]. [Full Text].

  43. Files B, Brambilla D, Kutlar A, et al. Longitudinal changes in ferritin during chronic transfusion: a report from the Stroke Prevention Trial in Sickle Cell Anemia (STOP). J Pediatr Hematol Oncol. 2002 May. 24(4):284-90. [Medline].

  44. Borgna-Pignatti C, Castriota-Scanderbeg A. Methods for evaluating iron stores and efficacy of chelation in transfusional hemosiderosis. Haematologica. 1991 Sep-Oct. 76(5):409-13. [Medline].

  45. Kolnagou A, Economides C, Eracleous E, Kontoghiorghes GJ. Low serum ferritin levels are misleading for detecting cardiac iron overload and increase the risk of cardiomyopathy in thalassemia patients. The importance of cardiac iron overload monitoring using magnetic resonance imaging T2 and T2*. Hemoglobin. 2006. 30(2):219-27. [Medline].

  46. Wood JC. Diagnosis and management of transfusion iron overload: the role of imaging. Am J Hematol. 2007 Dec. 82(12 suppl):1132-5. [Medline].

  47. Jacobs EM, Hendriks JC, van Tits BL, et al. Results of an international round robin for the quantification of serum non-transferrin-bound iron: need for defining standardization and a clinically relevant isoform. Anal Biochem. 2005 Jun 15. 341(2):241-50. [Medline].

  48. Pootrakul P, Breuer W, Sametband M, et al. Labile plasma iron (LPI) as an indicator of chelatable plasma redox activity in iron-overloaded beta-thalassemia/HbE patients treated with an oral chelator. Blood. 2004 Sep 1. 104(5):1504-10. [Medline]. [Full Text].

  49. Kemna EH, Tjalsma H, Podust VN, Swinkels DW. Mass spectrometry-based hepcidin measurements in serum and urine: analytical aspects and clinical implications. Clin Chem. 2007 Apr. 53(4):620-8. [Medline]. [Full Text].

  50. Guyader D, Gandon Y, Deugnier Y, et al. Evaluation of computed tomography in the assessment of liver iron overload. A study of 46 cases of idiopathic hemochromatosis. Gastroenterology. 1989 Sep. 97(3):737-43. [Medline].

  51. Howard JM, Ghent CN, Carey LS, Flanagan PR, Valberg LS. Diagnostic efficacy of hepatic computed tomography in the detection of body iron overload. Gastroenterology. 1983 Feb. 84(2):209-15. [Medline].

  52. Bell H, Rostad B, Raknerud N, Try K. [Computer tomography in the detection of hemochromatosis] [Norwegian]. Tidsskr Nor Laegeforen. 1994 Jun 10. 114(15):1697-9. [Medline].

  53. Sheth S. SQUID biosusceptometry in the measurement of hepatic iron. Pediatr Radiol. 2003 Jun. 33(6):373-7. [Medline].

  54. Nielsen P, Kordes U, Fischer R, Engelhardt R, Janka GE. [SQUID-biosusceptometry in iron overloaded patients with hematologic diseases] [German]. Klin Padiatr. 2002 Jul-Aug. 214(4):218-22. [Medline].

  55. Brittenham GM, Badman DG. Noninvasive measurement of iron: report of an NIDDK workshop. Blood. 2003 Jan 1. 101(1):15-9. [Medline]. [Full Text].

  56. Avrin WF, Kumar S. Noninvasive liver-iron measurements with a room-temperature susceptometer. Physiol Meas. 2007 Apr. 28(4):349-61. [Medline].

  57. Ghugre NR, Enriquez CM, Gonzalez I, et al. MRI detects myocardial iron in the human heart. Magn Reson Med. 2006 Sep. 56(3):681-6. [Medline].

  58. Westwood MA, Firmin DN, Gildo M, et al. Intercentre reproducibility of magnetic resonance T2* measurements of myocardial iron in thalassaemia. Int J Cardiovasc Imaging. 2005 Oct. 21(5):531-8. [Medline].

  59. Wood JC, Enriquez C, Ghugre N, Tyzka JM, Carson S, Nelson MD. MRI R2 and R2* mapping accurately estimates hepatic iron concentration in transfusion-dependent thalassemia and sickle cell disease patients. Blood. 2005 Aug 15. 106(4):1460-5. [Medline].

  60. Sparacia G, Midiri M, D'Angelo P, Lagalla R. Magnetic resonance imaging of the pituitary gland in patients with secondary hypogonadism due to transfusional hemochromatosis. MAGMA. 1999 May. 8(2):87-90. [Medline].

  61. Sparacia G, Iaia A, Banco A, D'Angelo P, Lagalla R. Transfusional hemochromatosis: quantitative relation of MR imaging pituitary signal intensity reduction to hypogonadotropic hypogonadism. Radiology. 2000 Jun. 215(3):818-23. [Medline]. [Full Text].

  62. Karimi M, Jamalian N, Rasekhi A, Kashef S. Magnetic resonance imaging (MRI) findings of joints in young beta-thalassemia major patients: fluid surrounding the scaphoid bone: a novel finding, as the possible effect of secondary hemochromatosis. J Pediatr Hematol Oncol. 2007 Jun. 29(6):393-8. [Medline].

  63. Papakonstantinou O, Ladis V, Kostaridou S, et al. The pancreas in beta-thalassemia major: MR imaging features and correlation with iron stores and glucose disturbances. Eur Radiol. 2007 Jun. 17(6):1535-43. [Medline].

  64. Wood JC, Enriquez C, Ghugre N, Tyzka JM, Carson S, Nelson MD, et al. MRI R2 and R2* mapping accurately estimates hepatic iron concentration in transfusion-dependent thalassemia and sickle cell disease patients. Blood. 2005 Aug 15. 106(4):1460-5. [Medline]. [Full Text].

  65. Gandon Y, Olivié D, Guyader D, et al. Non-invasive assessment of hepatic iron stores by MRI. Lancet. 2004 Jan 31. 363(9406):357-62. [Medline].

  66. Jensen PD, Heickendorff L, Carlson I, et al. Expression of CD2 and activation markers on blood T-helper cell subsets in patients with transfusional iron overload. Transfus Med. 2001 Feb. 11(1):21-30. [Medline].

  67. Delaporta P, Kattamis A, Apostolakou F, Boiu S, Bartzeliotou A, Tsoukas E, et al. Correlation of NT-proBNP levels and cardiac iron concentration in patients with transfusion-dependent thalassemia major. Blood Cells Mol Dis. 2013 Jan. 50(1):20-4. [Medline].

  68. Angelucci E, Brittenham GM, McLaren CE, et al. Hepatic iron concentration and total body iron stores in thalassemia major. N Engl J Med. 2000 Aug 3. 343(5):327-31. [Medline]. [Full Text].

  69. Butensky E, Fischer R, Hudes M, et al. Variability in hepatic iron concentration in percutaneous needle biopsy specimens from patients with transfusional hemosiderosis. Am J Clin Pathol. 2005 Jan. 123(1):146-52. [Medline].

  70. Harmatz P, Butensky E, Quirolo K, et al. Severity of iron overload in patients with sickle cell disease receiving chronic red blood cell transfusion therapy. Blood. 2000 Jul 1. 96(1):76-9. [Medline]. [Full Text].

  71. Tobkes AI, Nord HJ. Liver biopsy: review of methodology and complications. Dig Dis. 1995 Sep-Oct. 13(5):267-74. [Medline].

  72. Fitchett DH, Coltart DJ, Littler WA, et al. Cardiac involvement in secondary haemochromatosis: a catheter biopsy study and analysis of myocardium. Cardiovasc Res. 1980 Dec. 14(12):719-24. [Medline].

  73. Thakerngpol K, Fucharoen S, Boonyaphipat P, et al. Liver injury due to iron overload in thalassemia: histopathologic and ultrastructural studies. Biometals. 1996 Apr. 9(2):177-83. [Medline].

  74. Telfer PT, Prestcott E, Holden S, et al. Hepatic iron concentration combined with long-term monitoring of serum ferritin to predict complications of iron overload in thalassaemia major. Br J Haematol. 2000 Sep. 110(4):971-7. [Medline].

  75. Franchini M, Gandini G, Veneri D, et al. Efficacy and safety of phlebotomy to reduce transfusional iron overload in adult, long-term survivors of acute leukemia. Transfusion. 2004 Jun. 44(6):833-7. [Medline].

  76. Porter JB. Concepts and goals in the management of transfusional iron overload. Am J Hematol. 2007 Dec. 82(12 suppl):1136-9. [Medline].

  77. Borgna-Pignatti C, Rugolotto S, De Stefano P, et al. Survival and complications in patients with thalassemia major treated with transfusion and deferoxamine. Haematologica. 2004 Oct. 89(10):1187-93. [Medline]. [Full Text].

  78. Buja LM, Roberts WC. Iron in the heart. Etiology and clinical significance. Am J Med. 1971 Aug. 51(2):209-21. [Medline].

  79. Jensen PD, Jensen FT, Christensen T, et al. Evaluation of myocardial iron by magnetic resonance imaging during iron chelation therapy with deferrioxamine: indication of close relation between myocardial iron content and chelatable iron pool. Blood. 2003 Jun 1. 101(11):4632-9. [Medline]. [Full Text].

  80. Temraz S, Santini V, Musallam K, Taher A. Iron overload and chelation therapy in myelodysplastic syndromes. Crit Rev Oncol Hematol. 2014 Jan 24. [Medline].

  81. Breccia M, Alimena G. Efficacy and safety of deferasirox in myelodysplastic syndromes. Ann Hematol. 2013 Jul. 92(7):863-70. [Medline].

  82. Nolte F, Höchsmann B, Giagounidis A, Lübbert M, Platzbecker U, Haase D. Results from a 1-year, open-label, single arm, multi-center trial evaluating the efficacy and safety of oral Deferasirox in patients diagnosed with low and int-1 risk myelodysplastic syndrome (MDS) and transfusion-dependent iron overload. Ann Hematol. 2013 Jan. 92(2):191-8. [Medline].

  83. Breccia M, Finsinger P, Loglisci G, Federico V, Santopietro M, Colafigli G. Deferasirox treatment for myelodysplastic syndromes: "real-life" efficacy and safety in a single-institution patient population. Ann Hematol. 2012 Sep. 91(9):1345-9. [Medline].

  84. Lee SE, Yahng SA, Cho BS, Eom KS, Kim YJ, Lee S. Improvement in hematopoiesis after iron chelation therapy with deferasirox in patients with aplastic anemia. Acta Haematol. 2013. 129(2):72-7. [Medline].

  85. Lee JW, Yoon SS, Shen ZX, Ganser A, Hsu HC, Habr D, et al. Iron chelation therapy with deferasirox in patients with aplastic anemia: a subgroup analysis of 116 patients from the EPIC trial. Blood. 2010 Oct 7. 116(14):2448-54. [Medline].

  86. Cappellini MD, Bejaoui M, Agaoglu L, et al. Prospective evaluation of patient-reported outcomes during treatment with deferasirox or deferoxamine for iron overload in patients with beta-thalassemia. Clin Ther. 2007 May. 29(5):909-17. [Medline].

  87. Barry M, Flynn DM, Letsky EA, Risdon RA. Long-term chelation therapy in thalassaemia major: effect on liver iron concentration, liver histology, and clinical progress. Br Med J. 1974 Apr 6. 2(5909):16-20. [Medline]. [Full Text].

  88. Modell B, Letsky EA, Flynn DM, Peto R, Weatherall DJ. Survival and desferrioxamine in thalassaemia major. Br Med J (Clin Res Ed). 1982 Apr 10. 284(6322):1081-4. [Medline]. [Full Text].

  89. Brittenham GM, Griffith PM, Nienhuis AW, et al. Efficacy of deferoxamine in preventing complications of iron overload in patients with thalassemia major. N Engl J Med. 1994 Sep 1. 331(9):567-73. [Medline]. [Full Text].

  90. Delea TE, Hagiwara M, Thomas SK, et al. Outcomes, utilization, and costs among thalassemia and sickle cell disease patients receiving deferoxamine therapy in the United States. Am J Hematol. 2008 Apr. 83(4):263-70. [Medline].

  91. Rose C. [Post transfusionnal iron overload] [French]. Rev Prat. 2006 Dec 15. 56(19):2141-5. [Medline].

  92. Savulescu J. Thalassaemia major: the murky story of deferiprone. BMJ. 2004 Feb 14. 328(7436):358-9. [Medline]. [Full Text].

  93. Olivieri NF, Brittenham GM, McLaren CE, et al. Long-term safety and effectiveness of iron-chelation therapy with deferiprone for thalassemia major. N Engl J Med. 1998 Aug 13. 339(7):417-23. [Medline]. [Full Text].

  94. Wanless IR, Sweeney G, Dhillon AP, et al. Lack of progressive hepatic fibrosis during long-term therapy with deferiprone in subjects with transfusion-dependent beta-thalassemia. Blood. 2002 Sep 1. 100(5):1566-9. [Medline]. [Full Text].

  95. Tanner MA, Galanello R, Dessi C, et al. A randomized, placebo-controlled, double-blind trial of the effect of combined therapy with deferoxamine and deferiprone on myocardial iron in thalassemia major using cardiovascular magnetic resonance. Circulation. 2007 Apr 10. 115(14):1876-84. [Medline]. [Full Text].

  96. Filosa A, Vitrano A, Rigano P, Calvaruso G, Barone R, Capra M, et al. Long-term treatment with deferiprone enhances left ventricular ejection function when compared to deferoxamine in patients with thalassemia major. Blood Cells Mol Dis. 2013 Aug. 51(2):85-8. [Medline].

  97. Sharma R, Anand R, Chandra J, Seth A, Pemde H, Singh V. Distal ulnar changes in children with thalassemia and deferiprone related arthropathy. Pediatr Blood Cancer. 2013 Dec. 60(12):1957-62. [Medline].

  98. Osborne RH, De Abreu Lourenço R, Dalton A, et al. Quality of life related to oral versus subcutaneous iron chelation: a time trade-off study. Value Health. 2007 Nov-Dec. 10(6):451-6. [Medline].

  99. Delea TE, Sofrygin O, Thomas SK, et al. Cost effectiveness of once-daily oral chelation therapy with deferasirox versus infusional deferoxamine in transfusion-dependent thalassaemia patients: US healthcare system perspective. Pharmacoeconomics. 2007. 25(4):329-42. [Medline].

  100. Taher AT, Temraz S, Cappellini MD. Deferasirox for the treatment of iron overload in non-transfusion-dependent thalassemia. Expert Rev Hematol. 2013 Oct. 6(5):495-509. [Medline].

  101. Porter JB, Elalfy MS, Taher AT, Aydinok Y, Chan LL, Lee SH, et al. Efficacy and safety of deferasirox at low and high iron burdens: results from the EPIC magnetic resonance imaging substudy. Ann Hematol. 2013 Jan. 92(2):211-9. [Medline]. [Full Text].

  102. Vichinsky E, Onyekwere O, Porter J, Swerdlow P, Eckman J, Lane P, et al. A randomised comparison of deferasirox versus deferoxamine for the treatment of transfusional iron overload in sickle cell disease. Br J Haematol. 2007 Feb. 136(3):501-8. [Medline]. [Full Text].

  103. Cappellini MD, Cohen A, Piga A, et al. A phase 3 study of deferasirox (ICL670), a once-daily oral iron chelator, in patients with beta-thalassemia. Blood. 2006 May 1. 107(9):3455-62. [Medline]. [Full Text].

  104. Piga A, Galanello R, Forni GL, et al. Randomized phase II trial of deferasirox (Exjade, ICL670), a once-daily, orally-administered iron chelator, in comparison to deferoxamine in thalassemia patients with transfusional iron overload. Haematologica. 2006 Jul. 91(7):873-80. [Medline]. [Full Text].

  105. Cappellini MD, Cohen A, Piga A, Bejaoui M, Perrotta S, Agaoglu L, et al. A phase 3 study of deferasirox (ICL670), a once-daily oral iron chelator, in patients with beta-thalassemia. Blood. 2006 May 1. 107(9):3455-62. [Medline].

  106. Vichinsky E, Torres M, Minniti CP, Barrette S, Habr D, Zhang Y. Efficacy and safety of deferasirox compared with deferoxamine in sickle cell disease: two-year results including pharmacokinetics and concomitant hydroxyurea. Am J Hematol. 2013 Dec. 88(12):1068-73. [Medline].

  107. Meerpohl JJ, Antes G, Rücker G, Fleeman N, Motschall E, Niemeyer CM, et al. Deferasirox for managing iron overload in people with thalassaemia. Cochrane Database Syst Rev. 2012 Feb 15. 2:CD007476. [Medline].

  108. Naderi M, Sadeghi-Bojd S, Valeshabad AK, Jahantigh A, Alizadeh S, Dorgalaleh A, et al. A prospective study of tubular dysfunction in pediatric patients with Beta thalassemia major receiving deferasirox. Pediatr Hematol Oncol. 2013 Nov. 30(8):748-54. [Medline].

  109. Dubourg L, Laurain C, Ranchin B, Pondarré C, Hadj-Aïssa A, Sigaudo-Roussel D, et al. Deferasirox-induced renal impairment in children: an increasing concern for pediatricians. Pediatr Nephrol. 2012 Nov. 27(11):2115-22. [Medline].

  110. Lee JW, Kang HJ, Choi JY, Kim NH, Jang MK, Yeo CW, et al. Pharmacogenetic study of deferasirox, an iron chelating agent. PLoS One. 2013. 8(5):e64114. [Medline]. [Full Text].

  111. Yoshikawa T, Hara T, Araki H, Tsurumi H, Oyama M, Moriwaki H. First report of drug-induced esophagitis by deferasirox. Int J Hematol. 2012 Jun. 95(6):689-91. [Medline].

  112. Detry O, Defechereux T, Honore P, et al. [Combined liver and heart transplantation in a patient with thalassemia major] [French]. Rev Med Liege. 1997 Aug. 52(8):532-4. [Medline].

  113. Sardi B. High-dose vitamin C and iron overload. Ann Intern Med. 2004 May 18. 140(10):846; author reply 846-7. [Medline].

  114. Porter JB, Davis BA. Monitoring chelation therapy to achieve optimal outcome in the treatment of thalassaemia. Best Pract Res Clin Haematol. 2002 Jun. 15(2):329-68. [Medline].

  115. Adams RJ, McKie VC, Hsu L, et al. Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med. 1998 Jul 2. 339(1):5-11. [Medline]. [Full Text].

  116. Adams RJ, Brambilla D. Discontinuing prophylactic transfusions used to prevent stroke in sickle cell disease. N Engl J Med. 2005 Dec 29. 353(26):2769-78. [Medline]. [Full Text].

Iron status in iron deficiency and overload. NTBI = non–transferrin-bound iron; TIBC = total iron-binding capacity.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.