Transfusion medicine
Transfusion side effects
Transfusion associated iron overload

Author: Huy Phu Pham, M.D. (see Authors page)

Revised: 25 October 2017, last major update September 2011

Copyright: (c) 2002-2017,, Inc.

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

Cite this page: Pham, H.P. Transfusion associated iron overload. website. Accessed November 18th, 2018.
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