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Transfusion-Induced iron overload
source: Medscape
year: 2020
authors: Muhammad A Mir
summary/abstract:The human body has no active mechanism for the excretion of iron. During normal physiology, the amount of iron absorbed from the small intestine (1-2 mg/d) is balanced by the iron lost through sloughing of intestinal mucosa and skin, as well as the small amounts excreted in the urine and bile. Day-to-day iron requirements, as iron is needed by virtually all body cells and especially erythrocytes, are met by recycling between various compartments.
A unit of transfused blood contains approximately 250 mg of iron. In patients who receive numerous transfusions—notably those with thalassemia major, sickle cell disease, myelodysplastic syndrome, aplastic anemia, hemolytic anemia, and refractory sideroblastic anemias, who may become transfusion dependent—the excess iron from the transfused erythrocytes gradually accumulates in various tissues, causing morbidity and mortality.
Iron chelation therapy is used to prevent the accumulation of iron to harmful levels. Liver and cardiac transplantation should be considered for appropriate patients with end-stage disease.
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