Iron overload and toxicity: the hidden risk of multiple blood transfusions

被引:155
作者
Shander, A. [1 ]
Cappellini, M. D. [2 ]
Goodnough, L. T. [3 ]
机构
[1] Englewood Hosp & Med Ctr, Dept Anesthesiol Crit Care Med & Hyperbar Med, Englewood, NJ 07631 USA
[2] Univ Milan, Dept Internal Med, Mangiagalli Regina Elena Fdn IRCCS, Milan, Italy
[3] Stanford Univ, Sch Med, Dept Pathol & Med, Stanford, CA 94305 USA
关键词
chelation therapy; iron metabolism; iron overload; iron toxicity; transfusion; TRANSFERRIN-BOUND IRON; SERUM FERRITIN LEVEL; LONG-TERM EFFICACY; MYELODYSPLASTIC SYNDROMES; MAGNETIC-RESONANCE; THALASSEMIA MAJOR; CHELATION-THERAPY; BETA-THALASSEMIA; LIVER IRON; DEPENDENT THALASSEMIA;
D O I
10.1111/j.1423-0410.2009.01207.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background The quantity of iron in body is carefully regulated, primarily by control of iron absorption, and excess total body iron can be extremely toxic. Since humans have no mechanism for elimination of excess iron, multiple transfusions of red blood cells, which are required for the management of a number of disorders, inevitably result in iron overload. Cumulative iron overload, in turn, leads to iron toxicity with organ dysfunction and damage. Materials This review examines the relationship between iron metabolism and hematologic disorders treated with multiple transfusions, with emphasis on the diagnosis and current methods of management of iron overload and toxicity in transfusion-dependent patients. Primarily using key words, we identified and reviewed more than 100 pertinent articles in English and other languages in the Medline database plus an additional number of abstracts of presentations at recent meetings of relevant scientific associations. Results Transfusion-dependent disorders include those characterized by decreased red blood cell production, increased red blood cell destruction, or chronic blood loss. Patients receiving chronic transfusion therapy should be screened and monitored for iron overload, yet in our opinion, this is not always done routinely. Once iron overload has been identified, it should be treated to reduce the risk of morbidity and mortality from iron toxicity, which particularly affects the liver and heart. Conclusion Increased awareness of the risks of iron overload from chronic transfusion therapy should result in greater use of interventions such as iron chelation to reduce total body iron and the risk of long-term sequelae.
引用
收藏
页码:185 / 197
页数:13
相关论文
共 104 条
[51]  
Khumalo H, 1998, CLIN CHEM, V44, P40
[52]   Weighing the hazards of erythropoirsis stimulation in patients with cancer [J].
Khuri, Fadlo R. .
NEW ENGLAND JOURNAL OF MEDICINE, 2007, 356 (24) :2445-2448
[53]   Body iron metabolism and pathophysiology of iron overload [J].
Kohgo, Yutaka ;
Ikuta, Katsuya ;
Ohtake, Takaaki ;
Torimoto, Yoshihiro ;
Kato, Junji .
INTERNATIONAL JOURNAL OF HEMATOLOGY, 2008, 88 (01) :7-15
[54]   Magnetic resonance imaging evaluation of the pituitary gland and hypothalamus in thalassaemic children with elevated serum ferritin levels [J].
Lau, KY ;
Chan, YL ;
Lam, WWM ;
Li, CK ;
Metreweli, C .
JOURNAL OF PAEDIATRICS AND CHILD HEALTH, 1998, 34 (05) :463-466
[55]   Crystal structure of the hemochromatosis protein HFE and characterization of its interaction with transferrin receptor [J].
Lebrón, JA ;
Bennett, MJ ;
Vaughn, DE ;
Chirino, AJ ;
Snow, PM ;
Mintier, GA ;
Feder, JN ;
Bjorkman, PJ .
CELL, 1998, 93 (01) :111-123
[56]   The pH-induced release of iron from transferrin investigated with a continuum electrostatic model [J].
Lee, DA ;
Goodfellow, JM .
BIOPHYSICAL JOURNAL, 1998, 74 (06) :2747-2759
[57]   Liver disease in transfusion dependent thalassaemia major [J].
Li, CK ;
Chik, KW ;
Lam, CWK ;
To, KF ;
Yu, SCH ;
Lee, V ;
Shing, MMK ;
Cheung, AYK ;
Yuen, PMP .
ARCHIVES OF DISEASE IN CHILDHOOD, 2002, 86 (05) :344-347
[58]   IRON OVERLOAD CARDIOMYOPATHIES - NEW INSIGHTS INTO AN OLD DISEASE [J].
LIU, P ;
OLIVIERI, N .
CARDIOVASCULAR DRUGS AND THERAPY, 1994, 8 (01) :101-110
[59]   Impact of transfusion dependency and secondary iron overload on the survival of patients with myelodysplastic syndromes [J].
Malcovati, Luca .
LEUKEMIA RESEARCH, 2007, 31 :S2-S6
[60]  
Malcovati L, 2006, HAEMATOLOGICA, V91, P1588