Moxibustion with deferasirox results in safe, accelerated, and sustained cardiac iron chelation for a young Diamond Blackfan Anemia patient: An integrative case report

Diamond Blackfan Anemia (DBA) is a rare blood disorder of bone marrow failure typically identified in the first year of life. Due to treatment limitations, nearly all DBA patients are reliant upon chronic red cell infu-sion for some period of their lives. Repeat blood transfusion invariably leads to iron overload, which creates significant and life-threatening side effects. In this case report, a female child of 2 years and 8 months with DBA was diagnosed via T2* MRI imaging with potentially emergent levels of cardiac iron overload as a result of chronic red cell infusion. According to Chinese, Japanese, and integrative medicine principles, moxibustion was applied externally in conjunction with the prescribed oral chelation agent, deferasirox (DFX), over a period of six months. Analysis of repeat imaging at six months showed complete removal of cardiac iron and a one-third decrease in hepatic iron. In addition, there was no evidence of known risks to high-dose chela-tion, including renal, aural, or ocular damage. Follow-up examination two years after initial imaging showed no evidence of cardiac iron deposition with hepatic iron levels below minimum levels recommended for che-lation despite the medical necessity of continued red cell infusion. This case study suggests that an integra -tive medical approach combining DFX with moxibustion may safely accelerate and sustain iron chelation for transfusion-dependent DBA patients. Recommendations for a successful approach to integrative iron chela-tion are provided in the case discussion. ? 2020 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/)