Iron Overload
Iron overload is a medical condition that occurs when excess iron accumulates in the body. Left untreated, it can be a serious risk to health.
Patients with bone marrow failure diseases often require blood transfusions. This puts them at risk for developing iron overload. When patients receive ongoing transfusions, iron from transfused red cells can build up in the blood and eventually accumulate in the heart, liver, pancreas, and endocrine organs. If left untreated, excess iron may damage these vital organs and cause complications like liver disease, heart disease, and diabetes.
The Marrowforums discussion forums include a Transfusions and Iron Overload section where patients and family members can talk with each other about these issues.
Symptoms of Iron Overload
Symptoms of iron overload can vary from patient to patient. They may include:
  • fatigue
  • weakness
  • weight loss
  • abdominal pain
  • joint pain
  • for adolescents: abnormal puberty
  • for women: cessation of menstruation
Symptoms of severe iron overload include:
  • gray- or bronze-colored skin
  • shortness of breath
  • arthritis
  • liver disease
  • diabetes
  • heart problems
  • increased risk of liver cancer
  • enlarged spleen
  • shrunken testicles
Preventing and Detecting Iron Overload
Because not all patients develop noticeable symptoms of iron overload, patients who receive transfusions should take precautions and should have their iron levels monitored, so that treatment for iron overload can be started before organs are damaged or serious side effects develop.
If you receive transfusions of red blood, discuss iron overload with your doctor. It's not to soon to bring it up, even after only a few transfusions. Although regular transfusions may be necessary, there are steps you and your doctor can take to minimize your iron buildup and detect problems as soon as possible.
What you can do:
  • Keep track of the number of units of blood you receive by transfusion. In a single transfusion you may get one unit or more than one unit. It's the total number of units that matters. Problems may not develop for years, but for some patients they can develop after only 10 to 15 transfusions with a total of 20 to 30 red blood cell units.
  • Make sure that your iron is tested if you receive regular transfusions. The routine tests are for iron concentration, serum transferrin saturation, and serum ferritin. They should be repeated periodically while you are transfusion-dependent. The results will tell your doctor if treatment for iron overload is needed. A liver biopsy is sometimes performed to gather more information, but in recent years less invasive procedures have been more common, including a magnetic resonance imaging (MRI) test with the contrast weighted system called T2.
  • Avoid iron supplements and multivitamins with iron. Your doctor may also advise you to avoid iron-rich food and iron-fortified cereals.
  • Treat viral infections such as Hepatitis C promptly, since they can cause the liver to be damaged by iron very quickly and seriously.
Treating Iron Overload
Iron overload can be treated either by removing blood (phlebotomy) or by removing iron from blood (chelation).
With phlebotomy, blood is removed in a simple procedure, similar to blood donation. The procedure can be performed periodically for patients who are not anemic. Patients who are anemic (have low hemoglobin) cannot rely on phlebotomy to treat iron overload; they must rely on chelation.
With chelation, drugs are given to cause iron levels in the body to be reduced. These drugs are called chelators. Chelators include Desferal (deferoxamine), Exjade or Jadenu (deferasirox), and Ferriprox (deferiprone). Every drug can have side effects, so you and your doctor will need to discuss the choices. The treatment choice for chelation will depend on your medical history and condition, and may also involve issues of convenience, availability, and insurance coverage.
For More Information
Iron overload resources from the Aplastic Anemia & MDS International Foundation:
Other iron overload organizations (not specific to bone marrow failure diseases):