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Updated: May 31, 2026

Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Severe iron intoxication treated with exchange transfusion
M Carlsson1, D Cortes, S Jepsen
1Pediatric Intensive Care Unit, Odense University Hospital, Odense, Denmark.
Insights
Severe iron poisoning in a child was effectively treated with exchange transfusion (ET) when standard therapies failed. This critical intervention rapidly lowered dangerously high serum iron levels, leading to an uncomplicated recovery.
Area of Science:
- Pediatric Intensive Care Medicine
- Toxicology
- Hematology
Background:
- Iron poisoning is a leading cause of accidental ingestion deaths in children.
- Standard treatments like gastric lavage, whole bowel irrigation, and deferoxamine may be insufficient in severe cases.
Purpose of the Study:
- To report a case of severe iron poisoning successfully managed with exchange transfusion.
- To highlight the potential role of exchange transfusion in refractory iron overdose.
Main Methods:
- A pediatric patient with severe iron poisoning underwent standard decontamination and chelation therapy.
- Despite initial treatment, serum iron levels remained critically high, necessitating exchange transfusion (52 ml/kg).
Main Results:
- Following exchange transfusion, serum iron levels decreased significantly from 1362 µg/dl to 134 µg/dl.
- The patient experienced an uncomplicated recovery without long-term sequelae.
Conclusions:
- Exchange transfusion is a viable and potentially life-saving option for severe iron poisoning unresponsive to conventional therapies.
- Early consideration of exchange transfusion may improve outcomes in critical iron overdose cases.
Abstract:
An 18-month-old previous healthy girl who had ingested 442 mg elemental iron/kg was admitted to a paediatric intensive care unit. The child was treated with gastric lavage, whole bowel irrigation and intravenous deferoxamine. After 2 h of standard therapy serum iron had risen threefold to 1362 µg/dl (244 µmol/l). The child was treated with exchange transfusion (ET; 52 ml/kg) and serum iron fell to 134 µg/dl (24 µmol/l). The patient made an uncomplicated recovery. ET should be considered in severe iron poisoning when standard therapy is inadequate.
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