title: Geographical variations in current clinical practice on transfusions and iron chelation therapy across various transfusion-dependent anaemias.
abstract: OBJECTIVE
  Many patients with chronic anaemia require blood transfusions as part of their treatment regimen. As a result, iron overload will inevitably develop if not adequately managed by iron chelation therapy. There are many guidelines relating to transfusion and chelation practices for patients with transfusion-dependent anaemia; however, there is a lack of information on how treatment practices differ around the world. The objective of this manuscript is to highlight key features of current transfusion and chelation management, including similarities and differences across various anaemias and between geographical regions worldwide.
  
  
  METHODS
  Data collected at study entry to the multicentre Evaluation of Patients' Iron Chelation with Exjade (EPIC) study, which recruited 1,744 patients with a variety of transfusion-dependent anaemias across 23 countries from three geographic regions, were assessed. These analyses compared transfusion and chelation treatment prior to the start of study treatment, together with iron burden assessed at study entry by serum ferritin, liver iron concentration and labile plasma iron levels.
  
  
  CONCLUSIONS
  Data show that transfusion and iron chelation practices differ between anaemias and between geographical regions; this may be linked to availability and accessibility of transfusion and chelation therapy, patients' compliance, physicians' attitudes, costs and use of treatment guidelines. Approximately 60% of these transfusion-dependent patients were severely iron overloaded with a serum ferritin level over 2,500 ng/mL, indicating that the risks of iron burden may have been underestimated and current iron chelation therapy, if considered, may not have been adequate to control iron burden.
authors.affiliation: Siriraj Hospital, Mahidol University, Bangkok, Thailand. vip.vip@mahidol.ac.th
authors.forename: Vip
authors.initials: V
authors.lastname: Viprakasit
authors.forename: Norbert
authors.initials: N
authors.lastname: Gattermann
authors.forename: Jong Wook
authors.initials: JW
authors.lastname: Lee
authors.forename: John B
authors.initials: JB
authors.lastname: Porter
authors.forename: Ali T
authors.initials: AT
authors.lastname: Taher
authors.forename: Dany
authors.initials: D
authors.lastname: Habr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Martin
authors.forename: Gabor
authors.initials: G
authors.lastname: Domokos
authors.forename: Maria Domenica
authors.initials: MD
authors.lastname: Cappellini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005293:Ferritins / Q000097:blood; D019983:Guideline Adherence; D006801:Humans; D007501:Iron / Q000097:blood; D007502:Iron Chelating Agents / Q000008:administration & dosage*; D019190:Iron Overload / Q000097:blood / Q000517:prevention & control; D008099:Liver / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D065227:Transfusion Reaction
chemical_list: D007502:Iron Chelating Agents; D005293:Ferritins; D007501:Iron