[ 1 ]Figure 2.
(image)
Proposed treatment algorithm for iron overload in NTDT. This simple algorithm presents serum ferritin and LIC thresholds for initiating and stopping chelation therapy in NTDT patients based on current evidence.
Because patients with HbH disease typically accumulate iron much more slowly, serum ferritin and LIC monitoring can begin at 15 years instead of 10 years.
Iron chelation should be stopped at LIC of 3 mg Fe/g dw, or SF of 300 ng/mL, as safety data are not available to support continued chelation below this level.
I.e. ascorbic acid and serum transferrin levels, changes in marrow space observed during clinical examination or by means of Xray, assessment of liver spleen size plus height, hemoglobin concentrations.