What is transfusion-induced iron overload?

Updated: May 07, 2021
  • Author: Geneva E Guarin, MD, MBA; Chief Editor: Emmanuel C Besa, MD  more...
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The human body has no active mechanism for the excretion of iron. [1]  Normally, the amount of iron absorbed from the small intestine is balanced by the iron lost through sweat, menstruation, shedding of hair and skin cells, and rapid turnover and excretion of enterocytes, with daily absorption and excretion of iron both being about 1 mg in a healthy individual. [2, 3] Day-to-day iron requirements, as iron is needed by virtually all body cells and especially erythrocytes, are met by recycling between various compartments.

A unit of transfused blood contains approximately 250 mg of iron. [4] In patients who receive numerous transfusions—notably those with thalassemia majorsickle cell diseasemyelodysplastic syndromeaplastic anemiahemolytic anemia, and refractory sideroblastic anemias, who may become transfusion dependent—the excess iron from the transfused erythrocytes gradually accumulates in various tissues, causing morbidity and mortality. See Pathophysiology and Presentation.

Iron chelation therapy is used to prevent the accumulation of iron to harmful levels. Liver and cardiac transplantation should be considered for appropriate patients with end-stage disease. See Treatment and Medication.

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