A 45-year-old man with sickle cell disease (HbSS) has been on chronic transfusion therapy for secondary stroke prevention. His most recent serum ferritin is 3,200 ng/mL. Which iron chelating agent is indicated?
- A Deferasirox, an oral iron chelator ✓
- B Deferiprone only
- C Desferrioxamine via continuous intravenous infusion
- D No chelation is needed until ferritin exceeds 5,000 ng/mL
Correct answer: A. Deferasirox, an oral iron chelator
Explanation
Deferasirox is an oral iron chelator approved for transfusion iron overload in thalassemia and sickle cell disease, typically started when serum ferritin exceeds 1,000-1,500 ng/mL or after 10-20 transfusions. Desferrioxamine requires parenteral administration. Deferiprone is often used in combination or when others fail. Chelation should not be delayed until ferritin exceeds 5,000 as cardiac iron deposition occurs earlier.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.