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Iron chelators: Choice of agent, dosing, and adverse effects

Stanley L Schrier, MD
Bruce R Bacon, MD
Section Editor
William C Mentzer, MD
Deputy Editor
Jennifer S Tirnauer, MD


Phlebotomy cannot be used to remove excess iron in transfusion-dependent patients (eg, beta thalassemia major, severe beta thalassemia intermedia, sickle cell anemia, myelodysplasia, aplastic anemia) with iron overload or in the rare patient with hemochromatosis and an unstable hemodynamic status (eg, severe cardiac involvement) [1]. Thus, if treatment for iron overload is deemed necessary in such patients, one must use an iron chelating agent.

The use of chelating agents for the treatment of iron overload states in children and adults will be discussed here, with an emphasis on iron chelation therapy in thalassemia [2,3]. The following subjects are discussed separately:

Overviews of the causes and diagnosis of iron overload. (See "Approach to the patient with suspected iron overload" and "Methods to determine hepatic iron content".)

Treatment of iron overload using phlebotomy, which is available for non-anemic patients (eg, hereditary hemochromatosis). Such treatment is also available for formerly transfusion-dependent individuals (eg, thalassemia, sickle cell disease, myelodysplasia, aplastic anemia) who have been cured of their underlying disease following successful hematopoietic cell transplantation (HCT). (See "Management of patients with hereditary hemochromatosis", section on 'Phlebotomy' and "Thalassemia: Management after hematopoietic cell transplantation", section on 'Iron stores'.)

Monitoring iron stores and use of iron chelation in patients with sickle cell disease. (See "Red blood cell transfusion in sickle cell disease", section on 'Excessive iron stores'.)

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Literature review current through: Nov 2017. | This topic last updated: Jun 12, 2017.
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