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Iron overload and iron chelation therapy

Many people with a blood cancer or related blood disorder require blood transfusions at some time in their treatment regimen. Blood transfusions are very safe in Australia. Problems may occur when a person requires repeated blood transfusions over a period of time. One such problem is the potential for iron overload.

People who suffer from chronic anaemia, either from their disease, or their disease treatment, may become reliant on regular red blood cell transfusions. Transfusions help to alleviate symptoms of anaemia such as fatigue, lethargy, poor concentration and physical weakness helping to improve an individual’s quality of life and maintain independence.

What is Iron?

  • Iron is an important mineral in our body
  • It helps to maintain our bodies function and our immune system
  • It is responsible for ensuring that oxygen is transported around the body by the red cells. This oxygen is used by the body to create energy.

Where does iron come from?

  • Our body does not produce iron. We get iron from the food we eat.

How much iron do we require?

  • Normally our bodies process just enough iron from our diet to work effectively. 
  • The body does not have the ability to excrete or get rid of large amounts of iron. It loses small amounts each day through our skin and cells. Most of the iron in our body is recycled.
  • Iron is distributed throughout our body. The largest portion is in our blood where it binds to oxygen.
  • We also have a storage of iron in our bodies – particularly in the liver.

What causes iron overload?

  • Hereditary diseases such as haemochromatosis.
  • People who have regular blood transfusions may develop iron overload, as blood contains a large amount of iron. Conditions such as:

Thalassaemia

Sickle cell disease

Myelodysplastic Syndrome (MDS)

What is iron overload?

  • When there is excess iron in our body and our normal iron stores are full. Excess iron deposits could lead to potential health problems such as heart failure, liver damage and pancreatic or endocrine disorders like diabetes.

Symptoms of iron overload

  • chronic fatigue or tiredness
  • abdominal pain
  • skin colour changes (bronze, ashen)
  • aching joints
  • decrease libido or sex drive
  • impotencelow blood pressure
  • irregular heart rate
  • hair loss
  • depression

Screening and diagnosis of iron overload

  • A blood test known as a serum ferritin level is used to test for iron overload. Serum ferritin can indicate if there is too little or too much iron in your body.
  • An elevated serum ferritin level over a period of time may be indicative of iron overload. However serum ferritin levels can also be influenced by other factors such as inflammation.
  • Each treating centre has its own policy on the management of iron overload. Therefore it is important to discuss this with your doctor or nurse if you are having regular blood transfusions

Iron chelation

  • Treatment of iron overload is known as iron chelation therapy.
  • Iron chelation therapy works by binding to the iron and allows the body to excrete the bound particles.
  • Iron chelating agents come as a dissolvable tablet, Exjade (Deferasirox), or as a slow infusion, Desferrioxamine, under the skin or intravenously (into a vein).
  • Taking your iron chelating therapy is usually ongoing until your iron levels have normalised. This can be measured in a simple blood test, where your doctor checks your ferritin levels. How long you stay on these agents is a decision that has to be made by both you and your doctor.
  • Iron chelation therapy is known to have a range of side effects for many people. Sometimes these side effects may impact on a person’s quality of life enough that the dose of the medication has to be reduced. This is normal and your doctor will be looking for signs of this. Always talk openly with your doctor about how the drug is affecting you and together you can work on getting the best outcome for you.
  • It is important to note that iron chelation therapy is not suitable for all people.  However it is encouraged that you broach the subject with your doctor or nurse. All people should ask their doctor about their potential for iron overload after they have received a total of 20 bags of transfusion blood.

Useful links 

Further information can be found on the following web site explaining iron overload and its treatment in greater detail.

www.transfusion.com.au