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U.S. National Heart, Lung, and Blood Institute (NHLBI) guidelines for the management of sickle cell disease state that, even in patients who receive intermittent transfusions, "a comprehensive program to monitor and treat iron overload is necessary" (1).

NHLBI recommendations for monitoring iron overload

NHLBI guidelines state that (1):

• Screening for iron overload with serum ferritin testing is recommended at the onset of transfusions.
• Iron overload is likely to be detected after 20 transfusions.
• Liver biopsy is the most accurate test for confirming iron overload in SCD.

When to treat iron overload in SCD

NHLBI guidelines recommend treatment for iron overload when (1):

• Serum ferritin levels reach approximately 1000 mcg/L; or
• Cumulative transfusions equal about 120 mL/kg of packed red blood cells.

View the guidelines on the NHLBI website