IJzerchelation

IJzerchelation is a medical approach to reducing the body's iron burden by using chelating agents that bind iron and promote its elimination. It is used to treat iron overload resulting from chronic blood transfusions, such as in thalassemia major or myelodysplastic syndromes, as well as hereditary hemochromatosis in some cases. The aim is to prevent iron-induced damage to organs including the liver, heart, pancreas, and endocrine glands.

Mechanism and agents: Iron chelators are small molecules that form stable complexes with ferric iron (Fe3+). The resulting iron-chelate complexes are more water-soluble and are removed from the body through urine or bile. Three main chelators are deferoxamine (usually given by injection), deferasirox (oral, once daily), and deferiprone (oral, multiple daily doses). Each has a distinct pharmacokinetic profile and administration route, and choice depends on iron burden, organ involvement, tolerability, and patient preference.

Indications and monitoring: Chelation therapy is typically started when iron stores are elevated as measured by ferritin levels, transferrin saturation, and magnetic resonance imaging of liver iron content. Treatment duration is long-term and titrated to achieve a decline in body iron. Regular monitoring includes blood tests for ferritin and liver/kidney function, as well as periodic assessment of hearing and vision with some regimens.

Adverse effects and safety: Potential side effects vary by agent and can include infusion-related reactions, liver or kidney injury, gastrointestinal symptoms, or hematologic suppression. Because of this, chelation is administered under medical supervision with routine laboratory testing. Pregnancy and pediatric use require careful risk–benefit assessment.

See also: iron overload, deferoxamine, deferasirox, deferiprone.