Definition
Non-bleeding patients who receive multiple units of red cells (>10) are at risk of having excess iron stored in their body tissues leading to iron toxicity. This can damage organs such as the heart and liver.
Each unit of red cells contains about 200-250 mg of iron.
Frequency
Very Common in those transfused regularly/often (≥1/10).
Reducing the risk
Patients receiving long-term regular red cell transfusions (e.g., every three months or less) are at significant risk of developing iron overload, particularly those with Haemoglobinopathies such as sickle cell disease, thalassaemia, and other rare anaemias. To mitigate this risk, patients should undergo an annual review to assess for iron overload and related complications. Ferritin levels should also be monitored regularly, typically every 1 to 3 months, to identify trends and guide treatment.
Patients with significant iron overload may be considered for iron chelation therapy, with regular iron studies performed to evaluate the effectiveness of treatment and manage ongoing risks.
Further information/ resources
BSH Guidelines for the monitoring and management of iron overload in patients with haemoglobinopathies and rare anaemias
NICE Iron overload treatment summary