järnchelation

Iron chelation, or järnchelation in Swedish usage, is a medical intervention to remove excess iron from the body. It is used when iron accumulation results from frequent blood transfusions or iron absorption disorders. Iron overload can deposit in the liver, heart, pancreas, and endocrine glands, leading to organ dysfunction. If untreated, it increases the risk of liver disease, cardiomyopathy, diabetes, and other complications.

Chelating agents bind ferric iron (Fe3+) to form stable complexes that are excreted from the body. The main iron chelators used clinically are deferoxamine (parenteral), deferiprone (oral), and deferasirox (oral). Deferoxamine forms ferrioxamine excreted mainly in urine; deferasirox is absorbed orally and eliminated largely in feces; deferiprone forms soluble complexes excreted in urine. In some regimens, combinations are used to target different tissues or improve compliance.

Indications include transfusion-dependent anemias such as beta-thalassemia major, myelodysplastic syndromes, and other conditions causing chronic iron overload. Phlebotomy, an alternative for hereditary hemochromatosis, is usually unsuitable in patients with anemia. Monitoring includes ferritin levels, transferrin saturation, and imaging-based assessment of organ iron, with cardiac MRI (T2*) for cardiac iron load guiding therapy intensity.

Safety considerations vary by agent. Deferoxamine can cause infusion reactions, hypotension, and long-term auditory or vision effects. Deferiprone carries a risk of neutropenia and agranulocytosis and requires regular blood count monitoring. Deferasirox can cause renal and hepatic toxicity and gastrointestinal symptoms; adherence and monitoring of kidney and liver function are important. Clinicians balance iron reduction with potential adverse effects and adjust dosing accordingly.