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Updated: May 9, 2026
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Iron overload in children undergoing cancer treatments
Maëlle de Ville de Goyet1, Stéphane Moniotte, Annie Robert
1Department of Paediatric Haematology and Oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.
Insights
Pediatric cancer patients receiving frequent blood transfusions risk iron overload, impacting liver and heart health. Early screening is crucial for those with high transfusion volumes and treatment intensity.
Area of Science:
- Pediatric Oncology
- Hematology
- Radiology
Background:
- Iron overload is a significant cause of morbidity and mortality in patients requiring multiple blood transfusions.
- Pediatric cancer patients undergoing polytransfusion therapy are not routinely monitored for iron overload.
Purpose of the Study:
- To assess the prevalence and persistence of iron overload in pediatric cancer patients receiving transfusions.
- To identify risk factors associated with iron overload in this population.
Main Methods:
- Prospective enrollment of 75 pediatric cancer patients in a yearly monitoring protocol.
- Utilized cardiac and liver magnetic resonance imaging (MRI) and ferritin level measurements.
- Categorized patients into four groups based on the Intensity of Treatment Rating (ITR-3).
Main Results:
- Liver iron overload detected in up to 66% of patients at 1-year follow-up (n=59), correlating with transfused red blood cell volume.
- Myocardial iron overload observed in 14% of patients.
- Iron overload persisted for at least 2 years post-therapy initiation.
Conclusions:
- Severe liver and moderate myocardial iron overload are prevalent 1 year after cancer treatment and persist over time.
- Patients with higher ITR or receiving >1 liter of red blood cells/m² are at risk.
- Routine screening for iron overload is recommended for at-risk pediatric cancer patients.
Background:
Iron overload is responsible for severe morbidity and mortality in polytransfused patients. Although repeated blood transfusions are needed during the treatment of most cancers, pediatric patients are not routinely screened for subsequent iron overload.
Procedure:
Seventy-five patients were identified as candidates for cancer treatment and enrolled prospectively in a yearly protocol including a cardiac and liver magnetic resonance imaging coupled with ferritin level measurements. Patients were divided into four groups using the intensity of treatment rating (ITR-3).
Results:
Fifty-nine patients reached 1-year of follow-up and liver iron overload was found in up to 66% of them. Such overload correlated with the total volume of red blood cells transfused and persisted at least 2 years after the initiation of therapy. Moderate myocardial overload was also, but less frequently (14%), observed in these patients.
Conclusions:
Our study demonstrated that severe liver iron overload as well as moderate myocardial iron overload can be found 1 year after cancer treatment and that this overload persists overtime. The patients with higher ITR and those who have received more than a liter of blood red cells per square meter, regardless of their diagnosis or ITR, are at risk of iron overload and should be screened carefully.
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