Intensive Iron-Chelation Therapy with Desferrioxamine in Iron-Loading Anaemias

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Abstract
Urinary Fe excretion after desferrioxamine was examined in 9 patients with different Fe-loading anemias. Particular attention was paid to individual variation in response and the kinetics of Fe removal in order to determine the most efficient and convenient method of administration. Twelve hour s.c. infusions of desferrioxamine were comparable with i.v. infusions and gave a mean value of 62% more Fe excretion than similar i.m. bolus doses (range 20-125%). Increasing doses as 12 h s.c. infusions produced a linear increase in Fe excretion which was followed by a tendency to reach a plateau. Fe excretion varied greatly between patients, was not related solely to age or estimated Fe load, and in most cases was increased by ascorbic acid saturation. Maximum Fe-excretion rates were achieved after 3-6 h and then maintained throughout an infusion. With bolus injections excretion rates declined rapidly after the first 6 h, during which approximately 60% of the total Fe excretion occurred. The dose and method of administration should be tailor-made for each patient. Overnight 12 h s.c. infusions can be both as effective as similar doses given over 24 h and a practical way of achieving substantial negative Fe balance. Since children receiving regular blood transfusions for congenital anemias such as thalassemia usually die at the end of the 2nd decade, this approach to Fe chelation offers the possibility of alleviating what have hitherto been fatal Fe-loading states.