Iron chelation with deferoxamine: comparing the results of a critical pathway to a national survey.
OBJECTIVE
The clinical outcomes of an institution's critical pathway that uses a comprehensive approach to serum ferritin management are reported. The results of this center are compared with the results of a national survey of deferoxamine (DFO) use and serum ferritin level outcomes.


METHODS
Current DFO dosing and serum ferritin levels of 38 patients at this center were summarized. A questionnaire was then sent to 98 centers throughout the United States requesting information on criteria for beginning treatment with DFO, administration methods, dose modifications, and serum ferritin levels.


RESULTS
The application of a critical pathway in this program resulted in 29 of 38 patients maintaining serum ferritin levels <2,000 ng/mL. Of the 42 institutions that responded to the survey, 10 attained this ferritin level in > or =50% of their patients. Ferritin levels ranged from 500 ng/mL to >20,000 ng/mL, and wide variations were reported in all study parameters.


CONCLUSIONS
Iron overload can be effectively managed with alteration of DFO doses and routes using a consistent approach. Modification of administration methods, including administration of DFO during red blood cell transfusions, are indicated to attain ferritin levels of <2,000 ng/mL.
DeSwarte-Wallace
J
J
Miller Children's Hospital at Long Beach Memorial Medical Center, California 90801-1428, USA.
Groncy
P K
PK
Finklestein
J Z
JZ
D000293:Adolescent; D015415:Biomarkers; D015913:Chelation Therapy; D002648:Child; D002675:Child, Preschool; D019091:Critical Pathways; D003625:Data Collection; D003676:Deferoxamine / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D005293:Ferritins / Q000097:blood*; D006040:Goals; D006453:Hemoglobinopathies / Q000097:blood / Q000150:complications / Q000628:therapy; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D007279:Injections, Subcutaneous; D007501:Iron; D007502:Iron Chelating Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019190:Iron Overload / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D011795:Surveys and Questionnaires; D065227:Transfusion Reaction; D016896:Treatment Outcome
D015415:Biomarkers; D007502:Iron Chelating Agents; D005293:Ferritins; D007501:Iron; D003676:Deferoxamine