How is transfusion iron overload managed in patients with myelodysplastic syndromes (MDS)?

Updated: Nov 04, 2019
  • Author: Matthew C Foster, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Management of transfusion iron overload

  • For patients who survive long enough to receive over 20-30 U of packed RBCs, transfusion iron overload is probable
  • End-organ iron deposition may cause cardiac, hepatic, or endocrine dysfunction

  • Iron-chelating agents (deferoxamine, deferasirox) are available, but they have not been shown to decrease complications in MDS patients in prospective randomized trials. For this reason, many experts limit the use of these agents to patients likely to survive several years with transfusion dependence (eg, R-IPSS very-low-risk and low-risk patients).

  • Each iron-chelating agent has the following drawbacks: Deferoxamine is associated with inconvenient subcutaneous infusions, infusion-site reactions, and cataracts; deferasirox is an oral agent, but it is costly, requires monitoring of vision and renal and hepatic function, and is contraindicated in severe thrombocytopenia

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