Iron overload is a chronic condition that develops silently over years. This guide walks through the diagnostic workup, therapeutic options and long-term management principles - oriented for healthcare professionals and procurement teams.
1. Recognising Iron Overload #
Transfusional iron overload should be suspected in any patient who has received ~20-30 units of packed red cells cumulatively, or who has a serum ferritin persistently above 1000 ng/mL. Non-transfusional overload (NTDT, haemochromatosis) presents more insidiously via incidental ferritin elevation or family screening.
2. Diagnostic Workup #
- Serum ferritin - initial screen; can be falsely elevated by inflammation
- Transferrin saturation - useful in primary haemochromatosis
- LIC by MRI R2 / T2* - gold-standard non-invasive liver iron measurement
- Cardiac T2* - critical for patients with prolonged transfusion history
- Endocrine screen - for complications in long-standing disease
3. Treatment Thresholds #
Chelation is typically initiated when serum ferritin persistently exceeds 1000 ng/mL, LIC exceeds 5-7 mg Fe/g dry weight, or cumulative transfusion burden reaches clinically significant levels. Exact thresholds vary by disease and local guidelines.
4. Therapeutic Options #
- Deferasirox (once-daily oral) - standard of care in transfusional overload
- Deferiprone (three-times-daily oral) - selected indications
- Deferoxamine (subcutaneous infusion) - historical mainstay; reserved for selected cases
- Phlebotomy - first-line in non-anemic haemochromatosis
5. Long-Term Management #
Chelation is a lifelong commitment in most transfusion-dependent patients. Adherence is the single most important predictor of outcome - which favours once-daily oral therapy. Regular monitoring (ferritin monthly; LIC 6-12 monthly; cardiac T2* annually) guides dose adjustments.
6. Procurement Considerations #
For health systems, reliable access to WHO-GMP manufactured Deferasirox - with CTD dossier and tender-ready documentation - is essential. DEFRATAJ is manufactured in 5 strengths to support weight-based dosing across pediatric and adult populations.