Canterbury DHB

Context

Iron Overload - Transfusional

In New Zealand almost all the patients in this group will have myelodysplasia (MDS). Chelation therapy should be considered if the type of MDS has a favourable prognosis (assess the IPSS score) and the ferritin is in excess of 1500. Age itself is not relevant. The main factor to consider is whether there is a reasonable prospect of some years of good health, apart from the anaemia, and that the patient understands that chelation is an invasive form of treatment with some significant side effects. Some of these patients might benefit from erythropoietin but this is not yet funded for this purpose in New Zealand. The main chelating agent used is desferrioxamine.

Note: An oral chelating agent (deferasirox - Exjade®) has become available in New Zealand, funded by PHARMAC only for chronic iron overload due to congenital inherited anaemia. Seek Consultant advice with regard to the use of this drug.

In This Section

Desferrioxamine (DFO)

Desferrioxamine (DFO)

This should be started at a dose of 0.5 gm SC BD for 5-7 days of each week. This can be increased to between 10 and 50 mg/kg/day. It may be helpful to make sure the patient is not Vitamin C deficient. 100-200 mgs of ascorbic acid daily PO should be given. Monitor by changes in ferritin levels. Routine measurement of iron excretion in urine is not recommended. It may however be helpful if the ferritin does not fall, in order to monitor whether increased doses of desferrioxamine are being more effective.

Note: These comments apply to adults, not children. If high doses of desferrioxamine are given, monitor vision and hearing – seek Consultant advice.

See:

About this Canterbury DHB document (6333):

Document Owner:

Mark Smith (see Who's Who)

Issue Date:

August 2017

Next Review:

August 2019

Keywords:

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Topic Code: 6333