Aluminum toxicity can occur in patients with chronic kidney disease who undergo bladder irrigation with aluminum-containing products, use phosphate binders that contain aluminum, or receive hemodialysis with a water source contaminated with aluminum. Thus, rapid progression through these stages is another indicator that chelation may be necessary.Īluminum toxicity is an off-label use for deferoxamine chelation therapy. Acute iron toxicity progresses through five clinical stages, with the most deadly consequences occurring within the first four days. Signs and symptoms of systemic toxicity include coagulopathy, cardiomyopathy, and hepatic and renal failure. Īnother indication for iron chelation is a cardiac T2* 500 mcg/dL are considered hazardous, and chelation should be initiated.
In this population, chelation should begin two years after transfusions start, serum ferritin levels greater than 1000 mcg/L, or when liver iron concentration (LIC) is greater than 3 mg Fe/g. These patients include those affected by Thalassemia, Sickle cell disease, myelodysplastic syndromes, ineffective hematopoiesis, and other inherited anemic disorders.
Transfusion-related iron overload occurs in patients that require frequent transfusions throughout their life. Clinicians can also use deferoxamine as an off-label treatment for aluminum toxicity in chronic kidney disease (CKD) patients. The FDA has not approved deferoxamine as first-line therapy for hereditary hemochromatosis unless there is a contraindication to phlebotomy. The definition of iron overload is serial ferritin levels above 800 to 3000 ng/mL.
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