Iron Chelation Therapy

Iron overload is a serious complication associated with transfusion-dependent anemias and anemias characterized by ineffective erythropoiesis. Iron accumulation is toxic to many tissues, causing heart failure, cirrhosis, liver cancer, growth retardation, and multiple endocrine abnormalities. Chelation therapy aims to balance the rate of iron accumulation from blood transfusions by increasing iron excretion in urine and/or feces with chelators. Three iron chelators are currently available to treat patients: one administered parenterally called deferoxamine (or desferrioxamine) and two oral chelators, deferiprone and deferasirox. Careful dose adjustment is necessary to avoid excess chelation as iron levels fall. A key factor for successful iron chelation is to achieve regular adherence to treatment regimens throughout life: while the convenience and tolerability of individual chelators are important in achieving this goal, other factors such as psychological well-being and family and institutional support also impact adherence and outcomes.