Iron Overload
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Contents |
Etiology
- transfusion associated
- congenital hemolytic anemia
- long-standing aplastic anemia
- surreptitious ingestion
Pathology
- iron-induced organ toxicity may be seen when > 500 mL/kg of total packed erythrocytes are admministered (1 unit is about 300 mL with hematocrit of 70-80%)
- endocrine disturbances, including diabetes mellitus
- cirrhosis
- growth retardation
- cardiac toxicity (may be fatal)
Genetics
- mutations in SLC11A2 are associated with progressive liver iron overload & normal to moderately elevated serum ferritin levels
Laboratory
- iron studies (% transferrin saturation)
Management
- transfusion-related iron overload:
- iron chelation therapy ( deferoxamine) when transferrin becomes fully saturated or evidence of iron-induced tissue damage
- gastric decontamination
-
- most efficacious when given within 30-45 minutes of ingestion
- contraindications: - ingestion of caustic agents, hydrocarbons, drugs known to cause abrupt loss of consciousness or seizures, foreign bodies, non-toxic substances - unconscious patients, patients with seizures, patients with potential for inability to protect airway, patients with intentional ingestion
- performed prior to administration of charcoal
- 34-40 French orogastric tube (adults)
- 150-200 mL aliquots of warm water or normal saline
- 5-10 liters total
- polyethylene glycol- electrolyte lavage solution
- dosage:
- also see hemochromatosis
- AVOID vitamin C supplements
More General Terms
Additional Terms
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 15, American College of Physicians, Philadelphia 1998, 2009
