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Uptodate Reference Title
Advantages and disadvantages of phlebotomy and iron chelation following hematopoietic cell transplantation
Advantages and disadvantages of phlebotomy and iron chelation following hematopoietic cell transplantation
Advantages
Disadvantages
Phlebotomy
Efficient
Safe
Inexpensive
Permits complete iron removal and normalizes body iron content
Iron removal is quantifiable
Requires sustained engraftment (not usable in the early post-transplant period)
Immediate effect on plasma iron/non-transferrin-bound iron
Requires access to a phlebotomy facility
Not appropriate for individuals with mixed chimerism
Iron chelation therapy
Efficient
Safe
Immediate effect on plasma iron/non-transferrin-bound iron unknown
Access to a phlebotomy facility not required
Can be used in individuals with hemoglobin <10 g/dL
Can be used in individuals with mixed chimerism
Expensive
Renal toxicity in patients receiving cyclosporine
Greater toxicity at lower levels of iron burden
Hepatic iron concentration is assessed at 18 months following hematopoietic HCT, after the patient is no longer receiving transplant-related medications. Refer to UpToDate for additional information regarding the management of the patient with thalassemia following HCT and additional details regarding iron chelating agents.
