DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20170337

Effect of intravenous Deferoxamine concomitant use with blood transfusion on serum ferritin in thalassemia major patients

Afshin Fathi, Firouz Amani, Samira Araghchin, Esmaeil Farzaneh

Abstract


Background: Subcutaneous Deferoxamineis often not tolerated by patients and its rejection leads to iron overload with its complications. So, other methods with better toleration and reduction of Deferoxamine consumption are necessary. The present study aimed to evaluate the effect of intravenous Deferoxamine infusion during blood transfusion on serum ferritin (SF) in thalassemia major patients.

Methods: In a retrospective cross-sectional study, thirty four patients with β-thalassemia major treated with monthly blood transfusion at Bu-Ali hospital in Ardabil city from April 2013 to April 2014, were selected and followed for six months. The mean SF rate and the needed subcutaneous Deferoxamine rates before intervention were considered as baseline. All patients received intravenous Deferoxamine concomitant with their routine monthly blood transfusion for six months. After six months mean values for ferritin, subcutaneous Deferoxamine were compared with baseline values. Collected data were analyzed using t-test and paired t-test by SPSS, version 18.P<0.05 was considered as significant.

Results: Compared with baseline, the subcutaneous Deferoxamine rate and ferritin level have been decreased significantly after intervention.

Conclusions: Intravenous Deferoxamine concomitant use with routine monthly blood transfusion in thalassemia major patients can lead to decreasing of ferritin level. With this method, patient care could be improved, health care costs and complications of treatment effectively reduced.


Keywords


Beta-thalassemia, Blood transfusion, Deferoxamine

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References


Fisher SA, Brunskill SJ, Doree C, Gooding S, Chowdhury O, Roberts DJ. Desferrioxamine mesylate for managing transfusional iron overload in people with transfusion-dependent thalassaemia. Cochrane Database Syst Rev 2013;8:CD004450.

Cunningham MJ. Update on thalassemia: clinical care and complications. Hematol Oncol Clin North Am. 2010;24(1):215-27.

Weatherall DJ, Clegg JB. Inherited haemoglobin disorders: an increasing global health problem. Bull WHO. 2001;79(8):704-12.

Moradi GH, Ghaderi E. Chronic disease program in Iran: Thalassemia control program. Chron Dis J. 2013;1(2):98-106.

Saki N, Dehghani-Fard A, Kaviani S. Beta thalasemia: Epidemiology, diagnostic and treatment approach in Iran. Genet 3rd Millen. 2012;10(1):2675-83.

Abolghasemi H, Eshghi P. Comperehensive Textbook of Thalassemia, 1st ed, Iran. Medical University of Baghiatollah; 2004:189-201.

Orkin SH, Fisher DE, Look AT. Nathan and Oski̛ s Hematology of Infancy and Childhood. New York: Elsevier. 2009.

Piga A, Galanello R, Forni GL, Cappellini MD, Origa R, Zappu A, et al. Randomized phase II trial of deferasirox (Exjade, ICL670), a once-daily, orally-administered iron chelator, in comparison to deferoxamine in thalassemia patients with transfusional iron overload. Haematologica. 2006;91(7):873-80.

Cappellini MD, Cohen A, Piga A, Bejaoui M, Perrotta S, Agaoglu L and et al. A phase 3 study of deferasirox (ICL670), a once-daily oral iron chelator, in patients with beta-thalassemia. Blood 2006;107(9):3455-62.

Laws HJ, Gobel U, Christaras A, Janssen G. Intensification of chelating-therapy in patients with thalassemia major. Klinische Pödiatrie. 2005;217(3):120-5.

Gamberini MR, De Sanctis V, Gilli G. Hypogonadism, diabetes mellitus, hypothyroidism, hypoparathyroidism: incidence and prevalence related to iron overload and chelation therapy in patients with thalassaemia major followed from 1980 to 2007 in the Ferrara Centre. Pediatr Endocrinol Rev. 2008;6(1):158-69.

Riaz H, Riaz T, Khan MU, Aziz S, Ullah F, Rehman A, et al. Serum ferritin levels, socio-demographic factors and desferrioxamine therapy in multi-transfused thalassemia major patients at a government tertiary care hospital of Karachi, Pakistan. BMC Research Notes. 2011;4:287.

Davis BA, Porter JB. Long-term outcome of continuous 24-hour deferoxamine infusion via indwelling intravenous catheters in high-risk beta-thalassemia. Blood. 2000;95(4):1229-36.

Yarali N, Fişgin T, Duru F. Subcutaneous bolus injection of deferoxamine is an alternative method to subcutaneous continuous infusion. J Pediatr Hematol Oncol. 2006;28:11-6.

Wali YA, Taqi A, Deghaidi A. Study of intermittent intravenous deferrioxamine high-dose therapy in heavily iron-loaded children with beta-thalassemia major poorly compliant to subcutaneous injections. Pediatr Hematol Oncol. 2004;21(5):453-60.

Hagege I, Becker A, Kerdaffrec T. Long-term administration of high-dose deferoxamine 2 days per week in thalassemic patients. Eur J Haematol. 2001;67(4):230-1.

Tanner MA, Galanello R, Dessi C. A randomized, placebo-controlled, double-blind trial of the effect of combined therapy with deferoxamine and deferiprone on myocardial iron in thalassemia major using cardiovascular magnetic resonance. Circulation. 2007;115(14):1876-84.

Anderson LJ, Westwood MA, Holden S. Myocardial iron clearance during reversal of siderotic cardiomyopathy with intravenous desferrioxamine: a prospective study using T2 cardiovascular magnetic resonance. Br J Haematol. 2004;127(3):348-55.

Mashhadi MA, Rezvani AR, Naderi M, Moghaddam EM. The best iron chelation therapy in major thalassemia patients is combination of desferrioxamine and deferiprone. Int J Hematol-Oncol Stem Cell Res. 2011;5(2):19-22.

Xia S, Zhang W, Huang L, Jiang H. Comparative efficacy and safety of deferoxamine, deferiprone and deferasirox on severe thalassemia: a meta-analysis of 16 randomized controlled trials. PLoS One. 2013;8(12):e82662.

Calvaruso G, Vitrano A, Di Maggio R. Deferiprone versus deferoxamine in thalassemia inter media: Results from a 5-year long-term Italian multicenter randomized clinical trial. Am J Hematol 2015;90(7):634-8.

Elalfy MS, Adly AM, Wali Y. Efficacy and safety of a novel combination of two oral chelatorsdeferasirox/ deferiprone over deferoxamine/ deferiprone in severely iron overloaded young beta thalassemia major patients. Eur J Haematol. 2015;95(5):411-20.