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Updated: Jan 2, 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 transfusion-dependent patients
1Hematology Section, Children's Center for Cancer, Blood Diseases and Bone Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA.
Insights
Effective iron chelation has dramatically improved survival for patients with transfusion-dependent anemias. However, long-term iron exposure now presents new risks like cancer, requiring updated therapeutic strategies.
Area of Science:
- Hematology
- Cardiology
- Endocrinology
Background:
- Transfusion-dependent anemias historically led to early death from iron overload.
- Iron overload affects multiple organs, including the heart, liver, pancreas, and pituitary gland.
- Advances in iron monitoring and chelation therapy have significantly improved patient survival.
Abstract:
Before the advent of effective iron chelation, death from iron-induced cardiomyopathy occurred in the second decade in patients with transfusion-dependent chronic anemias. The advances in our understanding of iron metabolism; the ability to monitor iron loading in the liver, heart, pancreas and pituitary; and the availability of several effective iron chelators have dramatically improved survival and reduced morbidity from transfusion-related iron overload. Nevertheless, significantly increased survival brings about new complications such as malignant transformation resulting from prolonged exposure to iron, which need to be considered when developing long-term therapeutic strategies. This review discusses the current biology of iron homeostasis and its close relation to marrow activity in patients with transfusion-dependent anemias, and how biology informs clinical approach to treatment.
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