Transfusion-Induced Iron Overload Follow-up

Updated: May 07, 2021
  • Author: Geneva E Guarin, MD, MBA; Chief Editor: Emmanuel C Besa, MD  more...
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Follow-up

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. These cases should be managed with a multidisciplinary team approach.

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Transfer

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. [119]

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Deterrence/Prevention

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. [48]

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Complications

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

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Prognosis

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. [78] 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. [86] Failure to control serum ferritin over prolonged periods is also associated with an increased risk of cardiac disease and death. [25]

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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 signs and symptoms of heart failure, cirrhosis, and diabetes.

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