Transfusional Iron Overload

Children with thalassemia, sickle cell disease, or other anemias that require chronic blood transfusions may accumulate too much iron in their bodies – called iron overload. Because your child’s body has no natural way to remove the excess iron, the body stores it in internal organs and body tissues. This can cause damage to the liver, pancreas, heart and endocrine glands and may affect a child’s growth or development into puberty.

To address iron overload, most children with transfusion-dependent anemia also receive iron chelation drugs, which help remove the excess iron. The most effective blood transfusion and iron chelation regimen will differ significantly from child to child, and it will change over time as the child grows into adulthood.

Transfusional Iron Overload Evaluations

To ensure your child continues to receive the most effective and appropriate treatment over time, she should receive an annual evaluation to detect possible areas of concern related to iron overload. Since every child’s case is unique, you should discuss with a doctor which tests your child will need, and if they are needed more or less frequently than once a year. 

A typical transfusional iron overload annual evaluation may include:

• Cardiac testing may include an echocardiogram, T2* MRI monitoring to assess cardiac iron, 24 Hour Holter Monitor or event recorder to diagnose arrhythmias and/or ECG (electrocardiogram)
• Liver and infection testing may include annual testing for hepatitis, Liver Function Enzyme Screening, and liver iron assessment using through biopsy or the non-invasive Ferriscan® technique.
• Endocrine function testing to assess hormone levels, bone density and fertility concerns
• Eye and Ear evaluations for cataracts, tinnitus and other possible side effects 
• Transfusion monitoring, including a review of transfusion complications and of pre-transfusion hemoglobin values
• Iron chelation program monitoring, including a review of chelation options, dosing, and effectiveness of current program
• Pulmonary function studies

Annual Iron Overload Evaluations at Dana-Farber/Boston Children’s

Dana-Farber/Boston Children's offers Annual Iron Overload Evaluations to children with transfusion-dependent anemia from around the world. Our experts specialize in particular blood disorder sub-types, including thalassemia and sickle cell disease, and have unique expertise in evaluating transfusion and iron chelation regimens for children. Our Center also can provide specialized MRI monitoring of body iron by Ferriscan® and T2* techniques for the liver and heart, which may not be available at many pediatric centers.

We will work with you and your referring physician to tailor iron chelation strategies from the drugs currently available and approved, and we participate in research studies of novel chelation agents to bring better choices to our patients in the future.

Schedule an Iron Overload Evaluation

To learn more, please call 1-617-355-8246 or fill in our appointment request form. One of our specialized nurse practitioners will discuss with you which annual evaluation components your child may need, as well as next steps for arranging an evaluation at Dana-Farber/Boston Children’s.