Iron overload: causes, assessment methods, significance in transplantation setting and therapeutically approaches

Posttransfusional iron overload is a relatively common complication related to long-term treatment of various haematological diseases. Haematopoietic stem cell transplant recipients - both allogenic and autologous - often present with iron overload because of exposure to red blood cell (RBC) transfusions during the initial treatment and in the post transplant period. Despite these there are also some conditions which contribute to increased risk for iron overload. A variety of early post transplantant complications including infections, liver function abnormalities, and hepatic sinusoidal obstruction syndrome have been connected with iron overload. The late morbidity of iron overload is primarily due to involvement of heart and liver. Iron overload has been reported to increase the risk of infections late after transplantation. It has been suggested that all candidates for and all survivors of haematopoietic stem cell transplantation HSCT should be screened for iron overload at various time points before and after transplantation. Serum ferritin is sensitive but not specific for iron overload and is a poor predictor of body iron burden. It can be used for iron overload assessment, but it is recommended to use it together with some other parameters. Adequate chelation therapy can reduce iron burden and complications and should be administered as soon as there are signs of iron overload. More studies are needed to better define the natural history of iron overload and its impact on late morbidity and mortality in transplant recipients.