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Secondary Iron Overload

by Candido E. Rivera, MD

Secondary iron overload occurs when iron accumulates in the body because people take too many iron supplements, receive a large number of blood transfusions, or have a disorder in which they cannot form red blood cells efficiently.

  • People often feel weak and tired.

  • Diagnosis is with blood tests to measure iron level.

  • Treatment is usually with drugs that bind and remove iron from the body (chelation).

Severe complications are less likely than in people who have hemochromatosis (see Hemochromatosis). However, some people develop complications involving the heart, the liver, and endocrine organs.

Causes

Secondary iron overload typically occurs in people who have disorders that impair red blood cell production. Such red blood cell disorders include

  • Inherited disorders of hemoglobin structure or function (for example, sickle cell disease, thalassemia, or sideroblastic anemias)

  • Disorders that cause abnormal breakdown of red blood cells (hemolytic anemias)

  • Disorders caused by poorly formed red blood cells (myelodysplasia)

In such disorders, the body sometimes increases the amount of iron it absorbs. However, the body cannot always use all of the iron because of the difficulty producing new red blood cells. In such cases, iron overload can occur.

Iron also can accumulate in the body when people take in too much iron from

  • Iron therapy given in excessive amounts or for too long

  • Repeated blood transfusions

Men and postmenopausal women do not usually need to take iron supplements. If they do take supplements, they may have excess iron in the body, although usually not enough to be dangerous.

Symptoms

People with mild iron overload usually have no symptoms. Others typically feel weak and fatigued. Severe iron overload causes the same symptoms as in hemochromatosis (see Hemochromatosis), such as bronze-colored skin, diabetes, joint pains, and erectile dysfunction.

Diagnosis

Secondary iron overload is diagnosed by blood tests that measure the levels of iron and proteins that bind and transport iron.

Treatment

The goal of treatment is to reduce the body's iron content. For some people, treatment is to remove blood (phlebotomy). However, many people with secondary iron overload also have anemia. Because phlebotomy worsens anemia, these people are given iron chelation therapy.

Iron chelation may be given by mouth using deferasirox or by an infusion which can be given under the skin (subcutaneous) or into a vein (intravenous) using deferoxamine. The infusion is usually given overnight. Side effects include digestive upset, low blood pressure, and severe allergic reaction (anaphylaxis). Sometimes people have hearing and vision loss with long-term use. Iron chelation drugs given by mouth are very effective in lowering the iron level in the body. Side effects of oral iron chelation include abdominal pain, diarrhea, and rash. The treatment sometimes causes liver and kidney damage, so blood tests are done periodically to monitor the function of these organs.

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