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Transfusion medicine

Tranfusion side effects

Transfusion associated iron overload


Reviewer: Huy Phu Pham, M.D. (see Reviewers page)
Revised: 5 November 2011, last major update September 2011
Copyright: (c) 2007-2011, PathologyOutlines.com, Inc.

General
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● Chronic transfusions cause iron overload, because each unit of pRBC contains 200250 mg of iron, and body has no mechanism to excrete excess iron
● Occurs mostly in patients with sickle cell anemia, thalassemia major or myelodysplastic syndrome
● Also associated with HFE mutation H63D in thalassemia patients, regardless of transfusion history (Indian J Pathol Microbiol 2007;50:82)

Pathophysiology
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● After saturating transferrin and macrophages, excess iron deposits in cytoplasm of liver, myocardial and endocrine cells, causing damage (Mod Pathol 2007;20 Suppl:S31, Haematologica 2006;91:ECR19, Saudi Med J 2004;25:1347, Histopathology 2006;48:808)
● May be related to high levels of Growth differentiation factor 15 (GDF15) and suppression of iron regulatory protein hepcidin (Nat Med 2007;13:1096)

Clinical manifestation
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● Early symptoms: abdominal discomfort, lethargy, fatigue; mild hepatomegaly
● Late findings similar to patients with idiopathic hemachromatosis: liver cirrhosis, cardiac failure, diabetes

Treatment
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● Start iron chelation therapy when ferritin ~ 1000 mcg/L
● Chelation therapy is effective to reduce complications of iron overload and improve quality of life
● Goal: maintain ferritin level at 10001500 mcg/L
● Both subcutaneous (deferoxamine) and oral (deferasirox) are available
● Poor patient compliance with subcutaneous/IV treatment; better compliance with oral agents (Am J Health Syst Pharm 2007;64:606)

Prevention
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● Use of erythropoiesis stimulating agents instead of transfusion (Future Oncol 2007;3:397)

End of Transfusion Medicine > Tranfusion side effects > Transfusion associated iron overload


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