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Secondary Iron Overload

(Secondary Hemochromatosis)

By James D. Douketis, MD, Professor, Divisions of General Internal Medicine, Hematology and Thromboembolism, Department of Medicine;Director, Vascular Medicine Research Program, McMaster University;St. Joseph's Healthcare Hamilton

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, a genetic disorder that causes iron overload. 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 as

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 of 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

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:

Diagnosis

  • Blood tests

Secondary iron overload is diagnosed by tests that measure blood levels of

  • Iron

  • Ferritin, a protein that stores iron

  • Transferrin, the protein that carries iron in blood when iron is not inside red blood cells

Treatment

  • Removal of blood or chelation

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 deferiprone or by an infusion of deferoxamine, which can be given under the skin (subcutaneous) or into a vein (intravenous).

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.

Deferoxamine infusion for iron chelation 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.

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • FERRIPROX
  • EXJADE
  • DESFERAL