Iron Chelation via IV drip

Guys,

I got a note from a Thal(Major) parent that their child(around 1 year of age) was recommended an IV drip after 4 transfusions. The child has so far taken 7 blood transfusions and since the last 3 transfusions, the Dr. has recommended that straight after the transfusion he should have iron chelator via IV drip

I am NOT sure if that is the way to go?

When does a person get Iron chelation through IV drip? Members --> Could you share your experiences?

-Narendra

IV desferal is common. Lisa always got it along with her transfusion and also went in once each week for IV desferal treatments. I was recently told that they are now giving it along with blood in the Maldives. I don't know how effective this method is compared to subcutaneous injection.

I used to get reactions when Desferal was given to me via I.V (intravenous)

Sahil asked me the same thing and I have replied about it to Sahil at http://www.thalassemiapatientsandfriends.com/index.php?topic=70.msg2815#msg2815

It varies person to person. So you have to give it a try at least once to know if you are allergic to Desferal via I.V

Take care, Peace!

Sajid,

Were you given benadryl along with the IV desferal? It is used to reduce the allergic reactions.

Hi Andy!

No, the doctors were just too scared to continue the process as I was having a really hard time breathing and turning blue fast. The doctors thought that it was temporary and might have given me something to cure after it happened (I forgot as it quite long ago and I was a kid and didn't know what was going around me). They recommended not to do it after I had the same experience the next time.

Take care, Peace!

I used to receive weekly peripheral IV (PIV) Desferal treatment when my Ferritin was extremely high. The Desferal was infused using a little timed pump that I carried in a hip pack and I would run the Desferal for 72 hours. This was a pretty effective way to bring down my Ferritin level, but it wasn't fun getting a needle prick for a catheter that stayed in my arm for the whole weekend. I hope this helps! 

My daughter received IV Desferal during transfusions additionally to the subcuteneous use. It was given to her after the transfusion and in a very very diluted form ,( I think it was 2 vials of Desferal in 100 ml of saline) again over a period of 1 to 2 hours.
But Dr. Agarwal always said that that method does not help much, unless the drip can be continued for 12-16 hrs.
IV Desferal is given in cases of high iron overload over a period of 2-3 days to reduce the iron level faster.But in normal iron overloads, the subcutenious method works the best.. the idea is to keep the desferal in your body as long as possible.

If even diluted desferal is given through IV after the transfusion it has to be very very slow.. my daughter had loads of problems, even when the speed was slightly increased.. breathlessness, allergic reactions etc.. since the body was already loaded with the blood.

IV Desferal is given in cases of high iron overload

Thanks for the update guys.

That is exactly what I was fearing for. This child is around a year old and has got 7 transfusions only. I do NOT even think he needs iron chelation as of now, but I wonder what the doctor is thinking when giving Desferal through IV. The child is in a place where Thal is pretty much unknown.

I have asked the parents what the serum ferritin level is and would get an idea only then.

-Narendra

Hello to all,

My personal opinion is that starting a child on desferal at the age of 1 is too young. I understand each country and treating doctor has their own guidlines but as noted on the data sheet for Desferal you will find more info. Also I have included a link from the cooleys anemia site with some handy info.

Novartis Data Sheet on Desferal link:
http://www.medsafe.govt.nz/Profs/datasheet/discontinued/desferalinj.htm

Cooleys Anemia Org Q and A on Desferal link:
http://www.cooleysanemia.org/sections.php?sec=2&tab=9&sub=74#11

Good luck
Miaki

Thanks Miaki,

The links were very helpful. I will pass on the information to the family of the child

-Narendra

waw  i start desferal for my son when he was 3 years old and i started blood infiusion he was 2 and half years old but with small dose of desferal  about the other country may be they have some rules a bout this ...
               

                                    khalifa
                              state of kuwait

Hi Narendra,

I just found some info about IV desf. Posting it for you. But subcutaenous infusion via pump is the most effective in iron chelation.

INFO

In patients with thalassemia major (TM) who are non-compliant with long-term deferoxamine (DFO) chelation, survival is limited mainly because of cardiac complications of transfusional siderosis. It was recently shown in a small group of TM patients with established cardiac damage that continuous 24-h DFO infusion via an indwelling intravenous (i.v.) catheter is effective in reversing cardiac toxicity.

Hope that helps!

BTW, a one year old child may not require desf at this stage.

Regards,
Namitha

Hello Members - Need info from you all...for this child's Chelation option

The Pre-chelation therapy Serrum Ferritin was below 500 - The Child had received only 4 transfusions when the Chelation through IV(although - they say the chelation solution was very dilute) was started.

I am NOT sure if this is the way to go. I heard the Chelation usually starts when the serum ferritin level reaches 1000, but don't know how to go about it if they started when it was 500 and currently the level is 700. Should such a child continue to be given chelation? (They are using IV drip of desferal) Should it be stopped? Members, please share your thoughts

In between, the chid is receiving transfusion - once a month and uses wheatgrass.

-Narendra

 Usually, 500-700 is quite low to start Desferal.. and as i said earlier, IV Desferal is not much effective. The Desferal has to remain in the body for as long as possible to be able to be most effective.. hence the subcuteneous use over 10-11 hrs.. if the drip can be give for such long hrs... only then it will help. Diluted Desferal used over a period of 3-4 hrs is really not effective at all.
IV Desferal is used in extreme caes of iron overload, when the IV is used over 36-48 hrs to bring down the iron level..
This is my experience.. but ofcourse others might have another opinion..

shikha

hi all! We(my sis and I ) used to have iron chelation via IV drip too, every after our BT. We used to have 4 vials for every 500ml D5 water and as for my sis 4 vials also but in a 500 ml saline (coz she's diabetic) and during weekends, a friend who is a nurse, juz come by to insert our IV,but that's when we used to have our transfussion every month. Now i do it sub-Q and by a pump.  2 vials for every 5ml distilled water