Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013;35(6):428-34.
doi: 10.5581/1516-8484.20130106.

Brazilian Thalassemia Association protocol for iron chelation therapy in patients under regular transfusion

Monica Pinheiro de Almeida Veríssimo  1 , Sandra Regina Loggetto  2 , Antonio Fabron Junior  3 , Giorgio Roberto Baldanzi  4 , Nelson Hamerschlak  5 , Juliano Lara Fernandes  6 , Aderson da Silva Araujo  7 , Clarisse Lopes de Castro Lobo  8 , Kleber Yotsumoto Fertrin  9 , Vasilios Antonios Berdoukas  10 , Renzo Galanello  11
Affiliations

Brazilian Thalassemia Association protocol for iron chelation therapy in patients under regular transfusion

Monica Pinheiro de Almeida Veríssimo et al. Rev Bras Hematol Hemoter. 2013.

Abstract

In the absence of an iron chelating agent, patients with beta-thalassemia on regular transfusions present complications of transfusion-related iron overload. Without iron chelation therapy, heart disease is the major cause of death; however, hepatic and endocrine complications also occur. Currently there are three iron chelating agents available for continuous use in patients with thalassemia on regular transfusions (desferrioxamine, deferiprone, and deferasirox) providing good results in reducing cardiac, hepatic and endocrine toxicity. These practice guidelines, prepared by the Scientific Committee of Associação Brasileira de Thalassemia (ABRASTA), presents a review of the literature regarding iron overload assessment (by imaging and laboratory exams) and the role of T2* magnetic resonance imaging (MRI) to control iron overload and iron chelation therapy, with evidence-based recommendations for each clinical situation. Based on this review, the authors propose an iron chelation protocol for patients with thalassemia under regular transfusions.

Keywords: Blood transfusion; Brazil; Chelation therapy; Deferasirox; Deferiprone; Iron chelating agents; Iron overload; Iron/metabolism; Magnetic resonance imaging; Practice guidelines as topic; Protocols; beta-Thalassemia.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interest

Figures

Figure 1
Figure 1
Iron chelation therapy for patients with thalassemia naïve to iron chelation
Figure 2
Figure 2
Iron chelation therapy for patients with thalassemia without cardiac iron overload
Figure 3
Figure 3
Iron chelation therapy for patients with thalassemia with cardiac iron overload
Figure 4
Figure 4
Iron chelation therapy for patients with thalassemia when magnetic resonance imaging is not available
See this image and copyright information in PMC

References

    1. Borgna-Pignatti C, Rugolotto S, De Stefano P, Zhao H, Cappellini MD, Del Vecchio GC, et al. Survival and complications in patients with thalassemia major treated with transfusion and deferoxamine. Haematologica. 2004;89(10):1187–1193. Comment in: Haematologica. 2004;89(10):1157-9. - PubMed
    1. Cunningham MJ, Macklin EA, Neufeld EJ, Cohen AR, Thalassemia Clinical Research Network Complications of beta-thalassemia major in North America. Blood. 2004;104(1):34–39. - PubMed
    1. Kirk P, Roughton M, Porter JB, Walker JM, Tanner MA, Patel J, et al. Cardiac T2* magnetic resonance for prediction of cardiac complications in thalassemia major. Circulation. 2009;120(20):1961–1968. Comment in: Circulation. 2009;120(20):1937-9. - PMC - PubMed
    1. Brittenham GM, Griffith PM, Nienhuis AW, McLaren CE, Young NS, Tucker EE, et al. Efficacy of deferoxamine in preventing complications of iron overload in patients with thalassemia major. N Engl J Med. 1994;331(9):567–573. Comment in: N Engl J Med. 1995;332(4):270-1. N Engl J Med. 1995;332(4):271-2. N Engl J Med. 1994;331(9):609-10. - PubMed
    1. Olivieri NF, Nathan DG, MacMillan JH, Wayne AS, Liu PP, McGee A, et al. Survival in medically treated patients with homozygous beta-thalassemia. N Engl J Med. 1994;331(9):574–578. Comment in: N Engl J Med. 1995;332(4):271; author reply 272-3; N Engl J Med. 1995;332(4):271-2; author reply 272-3; N Engl J Med. 1994; 331(9):609-10. - PubMed

LinkOut - more resources