Iron chelation therapy in Thalassemia major

Goal of chelation therapy is to decrease tissue iron to a safe level and to minimise level of non-transferrin bound iron (NTBI) which is mainly responsible for iron toxicity.

Chelation therapy should be started in following situations
- Serum ferritin is more than 1000 ng/ml or
- After 15-20 transfusions

Desferal (DFO) is a time tested and effective iron chelator. It is administered in the dose of 20-50 mg/ kg/day as subcutaneous infusion with the help of a pump. Desferal is less often used these days, because of high cost, need for parenteral administration and poor compliance.
Deferiprone (DFP) is cheap and orally effective and is a better iron chelator for cardiac iron overload than DFO . The recommended dose is 50-100 mg/kg/day in 3-4 divided doses . Regular CBC monitoring every 2-4 weeks is required as there is risk of agranulocytosis (< 1%)
Deferasirox (DFX) is a new synthetic oral iron chelator with a long half- life (8-16 hrs) and provides 24 hours protection from NTBI with once a day dose. Dose is 20-40 mg/kg/day and should be taken empty stomach dispersed in water or juice. It is effective and relatively safe. Renal and hepatic functions should be monitored every month.

Splenectomy is less often required these days because of better modern day management and should be avoided if possible.

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