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Current approach to iron chelation in children
Author(s) -
Aydinok Yesim,
Kattamis Antonis,
Viprakasit Vip
Publication year - 2014
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.12825
Subject(s) - chelation therapy , ineffective erythropoiesis , medicine , chelation , erythropoiesis , thalassemia , deferoxamine , iron deficiency , intensive care medicine , anemia , chemistry , organic chemistry
Summary Transfusion‐dependent children, mostly with thalassaemia major, but also and occasionally to a more significant degree, with inherited bone marrow failures, can develop severe iron overload in early life. Moreover, chronic conditions associated with ineffective erythropoiesis, such as non‐transfusion‐dependent thalassaemia ( NTDT ), may lead to iron overload through increased gut absorption of iron starting in childhood. Currently, the goal of iron chelation has shifted from treating iron overload to preventing iron accumulation and iron‐induced end‐organ complications, in order to achieve a normal pattern of complication‐free survival and of quality of life. New chelation options increase the likelihood of achieving these goals. Timely initiation, close monitoring and continuous adjustment are the cornerstones of optimal chelation therapy in children, who have a higher transfusional requirements compared to adults in order to reach haemoglobin levels adequate for normal growth and development. Despite increased knowledge, there are still uncertainties about the level of body iron at which iron chelation therapy should be started and about the appropriate degree of iron stores’ depletion.