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Intravenous Desferal ® for Transfusion Iron Overload

  1. The Desferal ® can be given as an infusion of 2 to 4 grams per day when given IV. Skin irritation limits subcutaneous administration to about 2.5 g/d. Patients who receive the larger doses should be watched carefully for toxicity, including renal or hepatic dysfunction. Reversible neurovestibular dysfunction occurred in some children who were treated with high doses of Desferal ® (greater than 50 mg/kg). This complication has not been reported in adults.

  2. TheDesferal ® is mixed in sterile water. With syringe pumps, the volume is limited to about 5 ml. This limits the quantity of Desferal® that can be given as only about 2.5 g can be dissolved in this volume. Infusion pumps which use the plastic reservoirs have a larger volume capacity and the Desferal ® is more dilute.

  3. Infusion tubing (preferably 12" in length) with a 25 or 27 g needle is used. The Desferal ® solution is filled to the end of the tubing so no air is present. The needle is inserted into the port for the Hickman or Portacath line.

  4. The infusion pump should be set to deliver the Desferal ® over about 12 to 16 hours.

  5. The initial infusion should be given in the presence of a physician for about 20 minutes. Patients can rarely have an anaphylactic reaction to the drug, and appropriate corrective measures including the cessation of the infusion should be instituted should this occur. Another problem which requires immediate cessation of infusion is the development of urticaria. More serious problems such as laryngeal edema have not been reported in patients with urticaria. However, the risk should not be taken.

  6. When testing the efficacy of Desferal ® therapy, 24 h urine collection should be performed on the 3d day for iron determination. This value should be compared with a preinfusion 24 h urine iron determination. In order to gain benefit from the use of Desferal ®, a 24 h excretion of 30 mg or more of iron is generally required, particularly for patients with significant ongoing transfusion requirements (each unit of blood contains about 220 mg of iron).

  7. Patients should be warned that their urine will take on an orange color. This is the iron which is being excreted.

  8. Patients should be encouraged to use the pump every day to maximize iron excretion. A minimum of about 5 days per week is needed to get adequate excretion in general, however.

  9. Ascorbic acid increases iron excretion with Desferal ®. Vitamin C can be given with the following provisos.



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