Iron Overload Complications and Need for Therapy：铁过载的并发症和治疗的需要.pptVIP

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2017-12-14 发布于江西
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Iron Overload Complications and Need for Therapy：铁过载的并发症和治疗的需要.ppt

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Iron Overload Complications and Need for Therapy：铁过载的并发症和治疗的需要

Core Burden of Disease (CU) Iron Overload: Complications and Need for Therapy John B. Porter, MDProfessor of HematologyUniversity College, London, UK Iron Distribution Turnover In Humans Iron Loading From Blood Transfusions 1 unit of blood contains approximately 200 mg of irona Normally, total body iron is approximately3 to 4 g Chronic transfusion-dependent patients have an iron excess of 0.3 to 0.7 mg/kg/day, equivalent to 4 to 10 g of iron per yearb Iron accumulates with repeated blood transfusion Organ Systems Affected byIron Overload Pituitary gland Heart Liver Pancreas Gonadal Complications of Iron Overload Cardiomyopathy and cardiac failure Hepatic cirrhosis Diabetes mellitus Impaired growth Hypogonadism and infertility Diseases Associated WithTransfusional Iron Overload β-thalassemia Other chronic anemias Fanconi anemia (hypoplastic anemia) Diamond-Blackfan anemia (red cell aplasia) Congenital dyserythropoietic anemias Sickle cell anemia Aplastic anemia Myelodysplastic syndromes (MDS) Initiation of Therapy for Iron OverloadCurrent Practice With repeated blood transfusions, iron rapidly accumulates in the body Chelation treatment is generally initiated after 10 to 20 transfusions or when serum ferritin 1000 μg/L Alternatively, if iron loading is unclear, LIC may be measured Liver Iron Concentration Accurately Reflects Total Body Iron Stores Liver Iron and Risk of Complications From Iron Overload Plasma Ferritin as a Monitor of Iron Loading Relatively non-invasive Inexpensive Obtained asroutine laboratory assay Values confounded by Inflammation Liver function Liver Iron Concentration and Serum Ferritin Change in serum ferritin over time reflects change in LIC Sequential evaluation of ferritin levels provides a good index of chelation historya Maintenance of serum ferritin 2500 μg/L significantly correlates with cardiacdisease-free survivalb,c,d,e Cardiac Disease and % of Time WithSerum Ferritin 2500 μg/L Ideal Properties of an Iron Chelator