Iron Overload – Transfusional

This section is currently being reviewed by Dr Amy Holmes. It was last reviewed by Dr Mark Smith in August 2017.

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.

Desferrioxamine (DFO)

This should be started at a dose of 0.5 mg 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 mg 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.


About this Canterbury DHB document (6337):
Document Owner:	Amy Holmes (see Who's Who)
Last Reviewed:	August 2017
Next Review:	August 2019
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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