DÄ internationalArchive46/2009The Treatment of Secondary Hemochromatosis: In reply

Correspondence

The Treatment of Secondary Hemochromatosis: In reply

Dtsch Arztebl Int 2009; 106(46): 764. DOI: 10.3238/arztebl.2009.0764b

Gattermann, N

LNSLNS Otto rightly points out that biosusceptometry with SQUID (“superconducting quantum interference device”) is a good method for measuring hepatic iron concentration. The disadvantage of the method is that the equipment is expensive and only 4 SQUID -machines are currently operational worldwide (one of those is in Hamburg). Otto is also right in that preventing iron overload is better than treating it. I also agree that prevention and treatment with iron chelators is expensive. However, Otto is not right in presenting erythrocyte exchange as a proved method of preventing iron overload in patients who are chronically in need of transfusions. In patients with sickle cell anemia, this approach is useful in order to lower the proportion of HbS carrying erythrocytes ant to thus prevent clinical complications. In contrast to transfusion treatment by itself, the simultaneous removal of damaged erythrocytes obviously counteracts iron overload. However, in patients with chronic bone marrow failure—for example, elderly patients with myeloplastic syndromes (much more common in central Europe and North America than patients with sickle cell anemia or thalassemia)—the desired prevention of iron overload cannot be realized by means of erythrocyte exchange. If these patients present every 2–3 weeks with Hb concentrations as low as 8–9 g/dL as a result of their ineffective erythropoiesis, it is of little benefit to them to have their own erythrocytes exchanged for someone else’s. In order to achieve a substantial increase of the Hb concentration, substantially more erythrocytes have to be transfused than apheresed during an exchange transfusion—the iron load is correspondingly high.
DOI: 10.3238/arztebl.2009.0764b

Prof. Dr. med. Norbert Gattermann
Klinik für Hämatologie, Onkologie und klinische Immunologie
Heinrich-Heine-Universität Düsseldorf
Moorenstr. 5, 40225 Düsseldorf, Germany
Gattermann@med.uni-duesseldorf.de

Conflict of interest statement
Professor Gatterman has received honoraria for speaking, travel expenses, and study support from Novartis Pharma GmbH (Ltd).
1.
Gattermann N: The treatment of secondary hemochromatosis [Therapie der sekundären Hämochromatose]. Dtsch Arztebl Int 2009; 106(30): 449–504. MEDLINE
1. Gattermann N: The treatment of secondary hemochromatosis [Therapie der sekundären Hämochromatose]. Dtsch Arztebl Int 2009; 106(30): 449–504. MEDLINE