IRON: How to Manage When There is Too Much or Too Little of It

Iron is an essential element for human development and function; when deficient or in excess, the impact on health is profound. Limitations in measuring iron levels has prompted emergence of novel detection strategies. Iron repletion methods are evolving with new indications for and formulations of intravenous iron. Iron chelation for those with chronic transfusion-dependent anemia has dramatically improved life expectancy. This session will focus on advances in understanding iron metabolism, novel diagnostic tools for iron measurement and identification and management of iron deficiency and iron overload.

Dr. Michelle Zeller will present a 3-step approach to iron deficiency that includes identification, investigation and management of underlying etiology and iron-repletion. She will contrast absolute and functional iron deficiency. Dr. Zeller will provide an update on indications for and selection of intravenous iron in different patient populations and address the need for judicious use of red blood cell transfusion. She will briefly touch upon the importance of iron deficiency recognition and repletion as a pillar of Patient Blood Management.

Dr. Yelena Ginzburg will discuss recent advances in our understanding of iron metabolism regulation and crosstalk with erythropoiesis and how this information can be translated to the clinical setting. She will summarize current standard tools for identifying iron deficiency in anemic patients, especially those with chronic inflammatory conditions, and explore how novel markers, such as hepcidin and erythroferrone, may benefit the diagnostician. Dr. Ginzburg will also touch briefly on several clinical challenges, evaluate the available evidence to further their management, and explore areas of uncertainty.

Dr. Thomas Coates will discuss, prior to effective iron chelation, death from induced iron cardiomyopathy occurred in the second decade in patients with transfusion dependent chronic anemias. The revolution in understanding of iron metabolism, the ability to monitor iron loading in the liver, heart, pancreas and pituitary, and the availability of several effective iron chelators have dramatically improved survival and reduced morbidity from transfusion related iron overload. With significantly increased survival, new complications like malignant transformation due to prolonged exposure to iron need to be considered in development of long-term therapeutic strategies.