Practical management of iron overload

The practical management of iron overload requires reliable estimation of body iron content and distribution as well as an understanding of how iron overload translates into clinical consequences. In this article, it will be seen that our ability to estimate the distribution of excess tissue iron, to predict its consequences and therefore to tailor treatment accordingly is surprisingly imprecise. Our understanding of how iron chelators best prevent these consequences is also limited. It will be seen that the safest and most effective ways of removing excess iron vary depending on the degree and rate of iron loading as well as the underlying condition being treated. Evidence of benefit in survival with chelation treatment takes many years to emerge and currently only exists for thalassaemia major patients treated with desferrioxamine. Long-term survival benefits have not been demonstrated in other iron-overloaded conditions or with other chelation regimens. In such circumstances, practical treatment protocols are necessarily based on inference rather than direct evidence.