[Secondary iron overload]

Secondary iron overload (SIO) constitutes a growing clinical problem, particularly in haematological diseases in which the improvements of life expectancy give the iron overload enough duration to play its own prognostic role. Iron may accumulate by two ways: transfusion and/(or) digestive hyperabsorption which is proportional to erythroïd plasma iron turnover. To properly evaluate the iron overloading one must be able to appreciate the cumulative red blood cell transfusion volumes. That is to say: weighting and counting red blood cell units. The magnitude of red blood cell precursor mass might be conveniently but indirectly evaluated by the measurement of the plasma transferrin receptor concentration. The group of haematological diseases, complicated by SIO to the contrary of primary haemochromatosis, is very heterogeneous. Some of them like hereditary dyserythropoiesis may not be obviously detectable on standard haematological observation. They can combine or not with hereditary haemochromatosis. A SIO must be treated when it may add a specific prognostic effect. In some cases, regular blood letting are usable without major problems. In all other cases iron chelation therapy is an effective way to reduce SIO, provided long term compliance is obtained.