When to start iron chelation therapy?
With regular transfusions, there is increasing iron load, requiring removal with use of a chelator, usually after 15 transfusions. At 10 mL/kg PRBC given every 3 weeks, an amount of 150 mL/kg is reached by one year. Amount of 0.8 mg iron would be present per mL of PRBC in the bag, equivalent to 120 mg (i.e., 150 × 0.8) iron/kg/year. For a child weighing 10 kg (1 year age), this would amount to 1200 mg iron per year from transfusions. In a normal individual, the intestinal iron absorption is 1-1.5 mg/day or 350-530 mg per year. Thus in a regularly transfused thalassemia major child, iron acquired from transfusions is 3-4 times above normal. After one year of transfusions, the serum ferritin reaches above 1500 µg/L. The serum ferritin level aids in the initiation of therapy but at least 2 values should be recorded before the start of chelation. The serum ferritin can be elevated if blood sample is taken during an active infection/inflammation. If there was some undocumented fever/inflamm
