UpToDate
UpToDate خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده: 4

Monitoring and management of deferoxamine adverse events

Monitoring and management of deferoxamine adverse events
Adverse effect Monitoring Actions
Ophthalmologic
  • Reduced night vision
  • Decreased visual acuity
  • Visual field defects
  • Pigmentary retinopathy
  • Optic neuropathy
  • Color vision defect
  • Cataracts
  • Obtain baseline vision screening and ophthalmologic examination.
  • Repeat vision screening and dilated ophthalmologic examination annually.
  • Hold deferoxamine for abnormalities.
  • Maintain therapeutic index <0.025.*
Audiologic
  • High frequency sensorineural hearing loss
  • Tinnitus
  • Obtain baseline audiography before starting chelation as some patients may have baseline abnormalities.
  • Repeat audiography annually.
  • Hold deferoxamine or reduce dose for significant change from prior assessment.
  • Maintain therapeutic index <0.025.*
Bone
  • Reduced vertebral height
  • Metaphyseal dysplasia
  • Perform sitting and standing height assessment every 3 months.
  • Obtain knee radiographs if signs or symptoms of dysplasia.
  • Reduce chelator dose if bone changes.
  • Maintain therapeutic index <0.025.*
Infection
  • Yersinia
  • Klebsiella
  
  • Obtain cultures as needed for signs or symptoms of infection.
  • Hold deferoxamine for fever.
Zinc deficiency
  • Zinc level annually.
  • Supplement if low.
Infusion site reactions
  • Examine infusion sites at each visit.
  • Rotate infusion sites.
  • Use more dilute concentration of deferoxamine.
  • For severe reactions, consider adding hydrocortisone to the infusion.
The risk of adverse effects with deferoxamine (Desferal), especially ophthalmologic, auditory, and bone effects, is increased when the iron burden is low relative to the dose of the chelator. The therapeutic index should be kept at <0.025 to reduce the risk of toxicity.* Refer to UpToDate for details of chelator selection, dosing, and adverse effects.
* The therapeutic index can be calculated with the following formula:
  • Therapeutic index = [Deferoxamine dose (mg/kg/day)] ÷ [serum ferritin (ng/mL)][1].
Reference:
  1. Porter JB, Jaswon MS, Huehns ER, et al. Desferrioxamine ototoxicity: Evaluation of risk factors in thalassaemic patients and guidelines for safe dosage. Br J Haematol 1989; 73:403.

Adapted from: Ware HM, Kwiatkowski JL. Evaluation and treatment of transfusional iron overload in children. Pediatr Clin North Am 2013; 60:1393.

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