9 - Iron Chelating Agents

Hemochromatosis

Iron overload

Why does hemochromatosis cause…

1. Bronze skin

2. Liver disease

3. DM

4. Arthropathy

5. Heart disorders

6. Hypogonadotropic hypogonadism

1. Due to iron deposits and stimulating melanocytes

2. Increased iron scars the liver → Cirrhosis

3. Iron does the same to the liver by becoming ROS → Pancreatitis → Less insulin → DM

4. Arthropathy → Iron can crystallize in joints

5. Iron even deposits in the heart

6. Same here, iron can deposit in the APG

Iron Chelation

Using drugs to help bind free iron/remove the amount of excess iron there is in the body

Why do patients who receive tranfusions often need iron chelating agents?

Because RBC transfusions come with a base amount of iron that can accumulate

Deferoxamine

• Function

• Administration

• ADR(3)

• Binds iron and gets excreted mostly by kidneys

• Given parenterally

• Retinal toxicity, auditory toxicity, bone abnormalities due to deferoxamine binding other metals and reducing iron which is needed in cartilage proliferation at growth plates

Deferiprone

• Function

• Administration

• Quirk

• ADR(1)

• A smaller, lipophillic chelator that can get into cells to reach deposited iron

• PO

• Can work well with Deferoxamine and shuttle iron to cells for Hb synthesis

• Neutropenia

Deferasirox

• Function

• Administration

• ADRs(2)

• Monitor how?

• Lipophilic chelator that binds iron and secreted via bile into stool

• PO

• Renal/hepatic

• Serum creatinine and LFTs