iron overload and transfusion complications

Question 1

what are the consequences of iron overload

Answer 1

Endocrine dysfunction
o	Impaired growth and pubertal development
o	Diabetes
o	Osteoporosis
Cardiac disease
o	Cardiomyopathy    
o	Arrhythmias
Liver disease
o	Cirrhosis
o	Hepatocellular cancer

Question 2

how is iron overload managed?

Answer 2

• 250mg of iron per unit of packed red cells
• Chronic anaemia drives increased iron absorption
• Venesection not feasible – already anaemic!
• Iron chelating drugs (eg desferrioxamine) necessary
• Chelators bind to iron which is then excreted

Question 3

other transfusion complications

Answer 3

Transfusion related
o Viral infection - HIV, Hepatitis B and C
o Alloantibodies – hard to crossmatch
o Transfusion reactions
Increased risk of sepsis – bacteria like iron!