Iron Overload: Implications in Hematology, Oncology, and HSCT Patients (207)

4:45 – 5:45 pm Thursday, September 13

1CNE Iron is a vital mineral which is essential for life. Humans obtain iron through ingestion in foods where absorption is tightly regulated. Iron is bound to transferrin for transport due to the ability of labile plasma iron to cause oxidative damage to tissues and organs. Iron loss occurs through desquamation of the small intestine and menses in women and equals 1–2 mg Fe/day, similar to absorption. Blood transfusions are a lifesaving therapy for hematology patients as well as oncology and hematopoietic stem cell transplantation (HSCT) patients. Anemia, a common side effect of cancer and chemotherapy, used to be treated with erythropoietin stimulators until concerns were raised about their effect on tumor growth. Blood transfusions are a safe, readily available method to increase patient’s hemoglobin and can be done easily in the outpatient setting. However, each unit of blood contains 200–250 mg of iron which is released as the transfused blood cells break down.

The body has no method to naturally excrete this excess iron and it accumulates in organs. Iron damage over time is a function of the amount of iron present, multiplied by time and genetic and environmental factors. As we learn more about the possible long-term effects of iron overload in addition to the short-term sequelae in hematology patients, increased attention is turning to evaluating and treating non-hematology patients for iron overload. This presentation will look at the pathophysiology, natural history and effects of iron on different patient populations, and different organ function including the possible carcinogenic effects of iron. Chelation methods and rationale for treatment options and goals of iron reduction will be reviewed. Results from a retrospective chart review of the Iron Overload Clinic/Program at CHLA will be presented to examine iron burden and treatment strategies for Oncology/HSCT patients.