From the Guidelines
A high iron saturation percentage (>45%) suggests iron overload, which could be due to hemochromatosis, multiple blood transfusions, or excessive iron supplementation, and requires immediate attention to prevent serious complications such as liver cirrhosis, diabetes, heart problems, and joint damage. I recommend getting a complete iron panel including ferritin, total iron binding capacity (TIBC), and serum iron to confirm the diagnosis, as serum iron parameters alone are often insufficient to ascertain iron overload 1. If hemochromatosis is suspected, genetic testing for HFE gene mutations should be considered.
Diagnosis and Treatment
Treatment typically involves therapeutic phlebotomy (removing 500ml of blood every 1-2 weeks) until ferritin levels normalize (usually below 50-100 ng/mL), followed by maintenance phlebotomy every 2-4 months, as recommended by the American Association for the Study of Liver Diseases hemochromatosis practice guideline 1.
- Avoid iron supplements, vitamin C with meals, and limit alcohol consumption as these can increase iron absorption.
- Reduce intake of red meat and iron-fortified foods.
- For severe cases, iron chelation therapy with medications like deferoxamine, deferasirox, or deferiprone might be necessary.
- Cardiac MRI can be used to diagnose cardiac iron overload and measure response to medical therapy, as it is a non-invasive modality that can identify when therapy is indicated 1.
- MRI can also be used for non-invasive quantification of liver, spleen, pancreas, and cardiac iron, which can guide diagnosis and management, especially in patients without homozygosity for p.C282Y and/or the presence of additional risk factors for hepatic iron overload 1.
Important Considerations
It is essential to note that untreated iron overload can lead to serious complications, and early identification of cardiac involvement in populations known to be susceptible is imperative 1. Therefore, it is crucial to take a proactive approach in diagnosing and treating iron overload to prevent long-term damage and improve quality of life.
From the Research
Iron Profile %Sat High
- Iron overload can occur due to various factors, including regular blood transfusions, and can lead to significant morbidity and mortality if not effectively treated with chelation therapy 2, 3.
- Deferasirox is an oral iron chelator that has been shown to be effective in reducing iron burden in patients with transfusional iron overload, including those with beta-thalassemia and myelodysplastic syndromes 2, 3.
- The efficacy and safety of deferasirox have been established in several studies, including a prospective randomized trial comparing phlebotomy with deferasirox for the treatment of iron overload in pediatric patients with thalassemia major following curative stem cell transplantation 4.
- Deferasirox has also been shown to be effective in reducing iron burden in hemodialysis patients with iron overload, with a manageable safety profile 5.
- In non-transfusion-dependent thalassemia, deferasirox has been evaluated in several studies and has been shown to yield a sustained reduction in iron burden, with a clinically manageable safety profile 6.
Treatment Options
- Deferasirox is a once-daily oral iron chelator that can be used to treat iron overload in patients with transfusional iron overload, including those with beta-thalassemia and myelodysplastic syndromes 2, 3.
- Phlebotomy is another treatment option for iron overload, particularly in patients with non-transfusion-dependent thalassemia 4.
- The choice of treatment depends on various factors, including the severity of iron overload, the patient's underlying condition, and the presence of any comorbidities.
Monitoring and Management
- Regular monitoring of iron burden is essential to ensure effective management of iron overload 2, 3.
- Serum ferritin and transferrin saturation (TSAT) are commonly used markers to monitor iron burden 5.
- Magnetic resonance imaging (MRI) can also be used to assess liver iron concentration (LIC) and cardiac iron levels 4.