Chronic Iron Overload and Chelation Therapy

Management of iron accumulation from repeated transfusions

Written by: Saygı Hospital Health Guide Editorial Board

Last updated: June 20, 2026

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Hematoloji department. Book Appointment →

What is Chronic Iron Overload and Chelation Therapy?

Chronic iron overload is a serious complication in patients receiving regular red cell transfusions for thalassemia major, MDS, sickle cell disease, or aplastic anemia. Each unit of red cells contains roughly 200 to 250 mg of iron, and the body has limited capacity for active iron excretion.

Iron deposits initially in the liver and then extends to the heart, pancreas, pituitary, and thyroid. Cardiac siderosis is the leading cause of death related to iron overload. T2-star MRI provides noninvasive measurement of liver and cardiac iron concentration.

Chelation is initiated once serum ferritin exceeds 1000 ng/mL or after roughly 20 transfusions. Three chelators are available: deferasirox (oral, once daily), deferiprone (oral, three times daily), and deferoxamine (subcutaneous or intravenous infusion). Combination chelation can be more effective in severe iron overload, particularly when there is cardiac involvement.

Symptoms

Bronze skin pigmentation

Hepatomegaly with abnormal liver function

Heart failure and arrhythmia

Diabetes mellitus from pancreatic siderosis

Growth delay and delayed puberty

Hypothyroidism and hypogonadism

Risk Factors

Need for regular red cell transfusions

Beta thalassemia major and intermedia

Myelodysplastic syndrome (MDS)

Sickle cell disease

Aplastic anemia

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

Serum ferritin rises above 1000 ng/mL
Heart failure or arrhythmia develops
Endocrine dysfunction begins to appear

Treatment Methods

Deferasirox (oral, single daily dose)

Deferiprone (oral, three times daily)

Deferoxamine (subcutaneous or intravenous infusion)

Combination chelation (deferiprone with deferoxamine)

T2-star MRI monitoring of liver and cardiac iron

Endocrine function monitoring and hormone replacement

Which Department to Visit?

You can visit our Hematoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Hematoloji Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.