Iron chelation therapy is a medical treatment designed to remove excessive iron from the body. It utilizes specialized medications, known as chelating agents, which bind to the accumulated iron. This therapy addresses conditions where the body has an unhealthy surplus of iron, preventing it from harming organs and systems.
The Need for Iron Chelation
Iron overload, also known as hemochromatosis, occurs when the body accumulates too much iron. The body has a limited natural ability to excrete excess iron, leading to its buildup in tissues and organs. This accumulation can become toxic, causing damage to cells and leading to serious health complications.
Excessive iron can injure various organs, including the heart, liver, pancreas, and endocrine glands. In the heart, this can lead to irregular heart rhythms and heart failure. In the liver, it may cause scarring (cirrhosis), an enlarged liver, or even liver cancer. Pancreatic iron accumulation can result in diabetes, and impacts on hormone glands can lead to issues like hypothyroidism or fertility problems. Conditions such as inherited hemochromatosis, thalassemia, sickle cell disease, and myelodysplastic syndromes often necessitate frequent blood transfusions, a common cause of iron overload, as each unit of transfused blood contains about 250 milligrams of iron.
How Chelating Agents Work
Chelating agents form a strong bond with excess iron in the bloodstream and tissues, illustrating how these agents effectively “grab” onto it. The term “chelate” comes from the Greek word for “claw.” Once bound, the iron-chelator complex becomes a stable compound the body can excrete, primarily through urine and feces. This reduces the amount of free, toxic iron circulating and stored in organs.
Several types of iron chelating drugs exist, each designed for binding and removal. Deferoxamine binds to iron in ferritin or non-transferrin bound iron, facilitating its excretion. Deferiprone and deferasirox chelate labile iron within cells. These agents offer various options for removing excess iron from the body.
Treatment Approaches and Monitoring
Iron chelation therapy involves various administration methods, tailored to patient needs and the specific chelating agent used. Deferoxamine is administered via subcutaneous (under the skin) or intravenous infusion, often requiring a portable pump worn for 8-12 hours daily, usually at night. Newer forms of deferasirox are available as oral tablets, offering convenient once-daily dosing. Deferiprone is another oral chelator, taken three times a day.
Regular medical monitoring is an ongoing component to assess iron levels and overall health. Blood tests are routinely performed, including serum ferritin levels (indicating iron stores) and liver and kidney function tests to check for side effects. Magnetic Resonance Imaging (MRI) scans can also measure iron accumulation in organs like the heart and liver. Treatment is often long-term, continuing until iron levels normalize or to manage chronic iron overload.
Expected Outcomes and Side Effects
The primary goal of iron chelation therapy is to prevent or reverse organ damage caused by iron overload, thereby improving a patient’s quality of life. By reducing excess iron, the therapy can mitigate issues such as heart failure, liver cirrhosis, and endocrine dysfunctions. Studies have shown that iron chelators are effective in reducing iron overload resulting from frequent blood transfusions. Early detection and consistent treatment can significantly reduce or even reverse organ damage.
While beneficial, iron chelation therapy can have potential side effects. Common, milder side effects may include gastrointestinal upset (nausea, vomiting, diarrhea) and skin reactions (rashes, itching).
More serious, though less frequent, side effects can involve changes in vision or hearing, or impact kidney and liver function. Healthcare professionals monitor for these side effects through regular blood tests and examinations, adjusting dosages or switching medications as needed.