Treating Iron Overload in Patients With Thalassemia Major
According to the Thalassaemia International Federation (TIF) Guidelines for Clinical Management, iron overload constitutes "the most important complication in β-thalassemia and the major focus of clinical management") (1).
TIF guidelines for monitoring iron overload
TIF guidelines recommend screening for iron overload at the onset of transfusions. Iron overload is likely to be detected after the first 10-20 transfusions (near age 3 years) (2):
- Monitor serum ferritin at least every 3 months
- Do not rely on serum ferritin alone
- Liver iron concentration — determined by biopsy or noninvasively by MRI or SQUID (biomagnetic susceptometry) — is the reference standard for estimating iron loading
When to treat iron overload in thalassemia major
TIF guidelines recommend treatment for iron overload when serum ferritin levels reach about 1000 mcg/L, or after the first 10-20 transfusions (2).