From the Guidelines
Elevated iron saturation should be treated with phlebotomy to remove excess iron and prevent organ damage, as recommended by the EASL clinical practice guidelines for HFE hemochromatosis 1. The goal of treatment is to reduce iron levels to normal, thereby preventing complications such as liver cirrhosis, diabetes, arthropathy, hypogonadism, and porphyria cutanea tarda.
- Phlebotomy should be carried out by removing 400–500 ml of blood (200–250 mg iron) weekly or every two weeks, with adequate hydration before and after treatment, and avoidance of vigorous physical activity for 24 h after phlebotomy 1.
- Before initiating phlebotomy, patients should be assessed for complications including diabetes mellitus, joint disease, endocrine deficiency (hypothyroidism), cardiac disease, porphyria cutanea tarda, and osteoporosis 1.
- Additionally, patients with elevated iron saturation should be monitored annually, and treatment should be instituted when ferritin levels rise above normal 1.
- It is also important to manage any complications that may arise, regardless of whether or not they are directly related to the iron overload, and to immunize patients against hepatitis A and B while they are iron overloaded 1.
From the FDA Drug Label
Deferasirox tablets are an iron chelator indicated for the treatment of chronic iron overload due to blood transfusions in patients 2 years of age and older. The answer to elevated iron saturation is that deferasirox is indicated for the treatment of chronic iron overload.
- Key points:
- Deferasirox is an iron chelator.
- It is used to treat chronic iron overload due to blood transfusions.
- The treatment is for patients 2 years of age and older 2
From the Research
Elevated Iron Saturation
Elevated iron saturation can be caused by various conditions, including hereditary hemochromatosis and secondary hemochromatosis.
- Hereditary hemochromatosis is a genetic disorder that leads to increased iron absorption, resulting in iron overload and potential organ damage 3.
- Secondary hemochromatosis, on the other hand, is caused by acquired anemia, such as thalassemia, and is characterized by ineffective erythropoiesis leading to increased duodenal uptake of iron 4.
Treatment Options
Treatment options for elevated iron saturation depend on the underlying cause.
- For hereditary hemochromatosis, phlebotomy is often the standard treatment, but iron chelators such as deferasirox can be used as an alternative, especially in patients who are intolerant or refractory to phlebotomy 5, 6.
- For secondary hemochromatosis, iron chelators such as deferasirox are often used to remove excess iron, as phlebotomy is not a suitable option 4.
- Other treatment options, such as erythrocytapheresis, may also be considered, especially in patients with hereditary hemochromatosis 6.
Diagnostic Testing
Diagnostic testing for elevated iron saturation typically involves measuring serum ferritin and transferrin-iron saturation levels.