What is iatrogenic (induced by medical treatment) hemosiderosis (a condition characterized by the accumulation of iron in the body due to repeated blood transfusions)?

From the Guidelines

Iatrogenic hemosiderosis should be managed with iron chelation therapy, specifically deferoxamine or deferasirox, in patients with low or INT-1 risk disease who have received or are anticipated to receive greater than 20 RBC transfusions, with the goal of decreasing ferritin levels to less than 1000 ng/mL. Iatrogenic hemosiderosis is an iron overload disorder caused by medical interventions, most commonly multiple blood transfusions, leading to organ damage over time 1. The condition develops because the body lacks an effective mechanism to excrete excess iron, which catalyzes the formation of harmful free radicals that damage cellular components and disrupt normal organ function.

Key Considerations

• Serum ferritin levels and associated organ dysfunction (heart, liver, and pancreas) should be monitored in patients with chronic RBC transfusion need 1.
• Iron chelation therapy has been shown to reverse some of the consequences of iron overload in MDS and other iron overload states, including improvement in cardiac iron content 1.
• The current clinical availability of oral iron chelators, such as deferoxamine and deferasirox, provides potentially useful drugs to treat this iron overload state 1.
• However, deferasirox has a black box warning due to reports of acute renal failure, hepatic failure, and cytopenias, emphasizing the need for close monitoring of patients on this therapy 1.

Treatment Approach

• Treatment should begin when serum ferritin consistently exceeds 1,000 ng/mL or after approximately 10-20 units of blood transfusions.
• Regular monitoring of serum ferritin, transferrin saturation, and organ function is essential, with chelation therapy adjusted based on these parameters.
• Prevention strategies include limiting unnecessary transfusions, using erythropoiesis-stimulating agents when appropriate to reduce transfusion needs, and careful monitoring of iron supplementation.

From the FDA Drug Label

Deferasirox tablets are indicated for the treatment of chronic iron overload due to blood transfusions (transfusional hemosiderosis) in patients 2 years of age and older. The FDA drug label does answer the question, Iatrogenic hemosiderosis is also known as transfusional hemosiderosis, and deferasirox is indicated for the treatment of this condition.

• Key points: + Deferasirox is used to treat chronic iron overload due to blood transfusions. + It is indicated for patients 2 years of age and older. + The safety and efficacy of deferasirox when administered with other iron chelation therapy have not been established 2, 3, 4.

From the Research

Definition and Causes of Iatrogenic Hemosiderosis

• Iatrogenic hemosiderosis refers to iron overload caused by repeated blood transfusions, which can lead to serious health complications 5, 6, 7, 8, 9.
• This condition is often seen in patients with chronic anemias, such as beta-thalassemia, sickle cell disease, and myelodysplastic syndrome, who require frequent blood transfusions 5, 6, 7, 8, 9.

Treatment Options for Iatrogenic Hemosiderosis

• Iron chelation therapy is necessary to prevent the consequences of hemosiderosis, and several chelators are available, including deferoxamine, deferiprone, and deferasirox 5, 6, 7, 8, 9.
• Deferasirox is an oral tridentate chelator that has been shown to be effective in reducing iron burden in patients with transfusional iron overload 5, 7, 9.
• The efficacy and safety of deferasirox have been demonstrated in several studies, including a systematic review and economic evaluation that found deferasirox to be a cost-effective strategy compared to deferoxamine in patients with beta-thalassemia major and sickle cell disease 8.

Benefits and Risks of Deferasirox Treatment

• Deferasirox has been shown to be well-tolerated in clinical trials, with a preference for oral administration over subcutaneous deferoxamine infusions 7.
• The most common adverse effects of deferasirox include gastrointestinal disturbances, skin rash, and renal impairment 7, 9.
• Deferasirox has been effective in reducing iron burden in pediatric oncology patients with secondary hemosiderosis, with a significant decrease in ferritin levels observed during treatment 9.

Economic Evaluation of Deferasirox Treatment

• The cost-effectiveness of deferasirox compared to deferoxamine has been evaluated in several studies, with results suggesting that deferasirox may be a cost-effective strategy in patients with beta-thalassemia major and sickle cell disease 8.
• However, the cost-effectiveness of deferasirox compared to deferiprone is less clear, and further research is needed to determine the long-term benefits and risks of chelation therapy 8.