Fast Five Quiz: Anemia in Myelodysplastic Syndrome

Emmanuel C. Besa, MD


May 12, 2021

Once patients with MDS have received more than 20 units of red blood cells via transfusion, a baseline serum ferritin level should be obtained. Monthly blood cell counts and levels of creatinine, liver enzymes, and serum ferritin should also be monitored. Iron chelation therapy should not be initiated until the serum ferritin level is at least 1000 ng/mL.

The serum ferritin threshold, which should prompt iron chelation, is still contended, and it is theorized that iron accumulation could have a role in AML transformation and increase risk for infectious complications. The National Comprehensive Cancer Network guidelines recommend the use of iron chelation therapy in patients with ferritin levels above 2500 ng/mL.

Although deferasirox, deferoxamine, or deferiprone are all recommended treatments for iron chelation in patients with MDS, their use is indicated only when serum ferritin levels exceed 1000 ng/mL or when the liver iron concentration is ≥ 3 mg/g dry weight. Deferoxamine should not be administered concurrently with red blood cell transfusion because this approach is ineffective in relieving iron overload. Deferasirox is a preferred iron chelation therapy for patients with MDS and iron overload; however, this therapy should not be started unless serum ferritin levels are at least 1000 ng/mL.

Learn more about the management of elevated serum ferritin levels.


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