Transfusion medicine
Transfusion side effects
Transfusion associated iron overload

Topic Completed: 1 September 2011

Revised: 5 April 2019

Copyright: 2002-2017,, Inc.

PubMed Search: Transfusion associated iron overload [title] "loattrfree full text"[sb]

Huy Phu Pham, M.D., M.P.H.
Page views in 2018: 89
Page views in 2019 to date: 76
Cite this page: Pham H. Transfusion associated iron overload. website. Accessed June 20th, 2019.
Definition / general
  • Chronic transfusions cause iron overload because each unit of pRBC contains 200 - 250 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)
  • 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 1000 - 1500 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)
Clinical manifestation
  • Early symptoms: abdominal discomfort, lethargy, fatigue; mild hepatomegaly
  • Late findings similar to patients with idiopathic hemachromatosis: liver cirrhosis, cardiac failure, diabetes
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