Iron chelation therapy is used when you have a condition called iron overload. Iron overload means you have too much iron in your body. This can be a problem for people who get lots of red blood cell transfusions. Since red blood cells contain iron, each time you get a red blood cell transfusion you are putting more iron in your body. Your body has no good way to get rid of the extra iron. This iron can build up in your vital organs and may injure them over time.
Extra iron that is not immediately needed to make new red blood cells is normally stored in the liver, spleen, and bone marrow. Excess iron may accumulate in these 3 organs and in other organs that don't normally store iron, such as the pancreas, heart, joints, and skin. This excess iron can damage these organs.
Only your doctor can decide if iron overload is a problem for you. To decide, your doctor will look at how many blood transfusions you have had and do blood tests to check how much iron is in your blood and body. The blood tests might include serum ferritin level, iron concentration, and transferrin saturation. It is possible your doctor may do other tests like a liver biopsy or an MRI (Magnetic Resonance Imaging) to understand if iron is building up in organs.
Early on, iron overload can cause no symptoms, or it can cause non-specific symptoms that are also seen in other conditions. Some of these symptoms include:
Women who have iron overload might stop getting their periods.
With severe iron overload, you may experience:
Ferritin levels are important for everyone. Whether you’re male or female, an avid exerciser or a couch potato. If your ferritin levels are too low, you may feel fatigued and run down. Fatigue can often be linked to inadequate iron in the blood. And since ferritin is a marker of long-term iron intake, it's perfect for determining whether that worn-down feeling can be linked to your diet. Analyzing the ferritin levels in your blood can help increase your energy levels and make tracking iron chelation therapy a snap.
Drugs called iron chelators remove extra iron from your body. There are two iron chelators approved by the U.S. Food and Drug Administration (FDA) for use in the U.S.
Deferoxamine (Desferal®) is usually administered by subcutaneous (under the skin) infusion using a small portable pump about the size of a CD player. The pump is worn for 8-12 hours a day, usually at night while sleeping. Many patients find taking deferoxamine difficult because of the need to carry around a pump.
Deferasirox is a newer iron chelator that now comes in two forms (see below). Deferasirox is not recommended for people with high-risk MDS.
Exjade® is a tablet form that must be dissolved in juice or water and taken (by mouth) once a day. Most patients tolerate it very well.
Jadenu® is a new tablet formulation of deferasirox approved for use in 2015. It is taken on an empty stomach or with a light meal once a day with water or other liquids.
One additional iron chelator is currently being used in Europe, Asia, and Canada, but is not yet approved by the FDA for use in the United States:
Deferiprone or L1 (Ferriprox™) comes in a pill form and is taken 3 times a day. It is generally well tolerated by patients, but it can cause a drop in white blood cell counts, so patients need to have their blood checked weekly while taking this drug (white blood cells protect you against infections).
KEEPING TRACK OF YOUR LEVELS CAN HELP YOU SPOT AN UPWARD OR DOWNWARD TREND
When your doctor gives you the results of your latest serum ferritin (SF) levels every month, record it here, and circle the red or green arrow below to show whether they have gone up or down since the last visit.
Consistently high SF levels (greater than 1000 mcg/L) may indicate too much iron in your body
If after 3-6 months, you start to see a trend in your SF levels, your dose may need to be adjusted. Bring this chart with you to your next doctor appointment, and talk to your doctor about how your therapy is working.
Lab Me does it automatically for you using easy-to-follow graphics and downloadable PDF reports.
For tracking serum ferritin we suggest either:
The At Home Overload Test Is Encouraged If Your Are Experiencing:
The ferritin test is just that - serum ferritin only. The overload kit tests the following:
Get started with Lab Me today in order to track your progress with iron chelation therapy.