Iron overload

Abstract

Iron overload is an uncommon disorder that requires a high level of clinical suspicion to ensure appropriate perioperative management. Chronic blood transfusions can result in iron overload as well as other rare intrinsic disorders of normal iron metabolism. Early signs and symptoms are nonspecific and end-organ involvement commonly occurs in advanced disease. High iron levels result in toxicity to organ tissues through the development of reactive oxygen species. In advanced disease, end-organ involvement can be fatal if severe cardiac or hepatic insult occurs. To assess total body iron levels in suspected patients, ferritin and transferrin saturation blood tests can be performed. Further diagnostic testing is guided by the degree of end-organ involvement. Appropriate risk stratification and preoperative workup is essential to mitigate the risk of perioperative complications. Usual treatment of excess iron burden involves iron chelation therapy and intermittent therapeutic phlebotomy.