How should I manage a patient with confirmed iron overload due to chronic transfusion therapy?

Management of a patient with confirmed iron overload due to chronic transfusion therapy primarily involves the initiation of iron chelation therapy to reduce excess iron and prevent organ damage, particularly cardiac complications. Iron chelation agents such as deferoxamine, deferiprone, or deferasirox are used to bind excess iron and facilitate its excretion, with treatment tailored to the severity of iron overload and patient tolerance Fernandes 2012. Regular monitoring of iron status is essential, including serum ferritin and transferrin saturation levels, to guide therapy and avoid further iron accumulation NICE NG203. Monitoring intervals typically range from 1 to 3 months depending on clinical context and treatment response NICE NG203. In addition to biochemical monitoring, assessment of organ function, especially cardiac and hepatic, is critical to detect iron-related toxicity early Fernandes 2012. Specialist referral to haematology or a multidisciplinary team experienced in managing transfusional iron overload is recommended to optimize chelation regimens and monitor for complications NICE NG203. Blood transfusion should be carefully evaluated and balanced against the risks of exacerbating iron overload, with discussions involving the patient about risks and benefits NICE NG203. Overall, the management strategy integrates regular iron status monitoring, appropriate iron chelation therapy, and multidisciplinary care to mitigate the risks associated with chronic transfusional iron overload NICE NG203 Fernandes 2012.