Iron chelation therapy

Iron overload is a pathological condition resulting from a congenital impairment of its regulation, increased intestinal iron absorption secondary to bone marrow erythroid hyperplasia, or a chronic transfusional regimen. In normal conditions, intracellular and systemic mechanisms contribute to maintaining iron balance. When this complex homeostatic mechanism fails, an iron overload could be present. Detecting an iron overload is not easy. The gold standard remains the liver biopsy, even if it is invasive and dangerous. Identifying iron using noninvasive techniques allowed a better understanding of the rate of iron overload in different organs, with a low risk for the patient. Estimating serum ferritin (mg/L) is the easiest and, consequently, the most employed diagnostic tool for assessing body iron stores, even if it could be a not specific method. The most common hematological causes of iron overload are myelodysplastic syndromes, sickle cell disease, and thalassemia. In all of these conditions, three drugs have been approved for the treatment of iron overload: deferiprone, deferoxamine, and deferasirox. These chelators have been demonstrated to help lower tissue iron levels and prevent iron overload complications, improving event-free survival (EFS). Nowadays, the decision to start chelation and which chelator to choose remains the joint decision of the clinician and patient.

Automated summary

Iron overload can be caused by a congenital impairment of iron regulation, increased intestinal iron absorption, or chronic transfusions. Diagnosing iron overload is challenging, with liver biopsy being the gold standard despite its invasiveness. Noninvasive techniques have allowed for better understanding of iron overload in different organs. Serum ferritin estimation is the most commonly used diagnostic tool, although it may not be specific. Hematological conditions such as myelodysplastic syndromes, sickle cell disease, and thalassemia can cause iron overload, which can be treated with chelators like deferiprone, deferoxamine, and deferasirox.