Iron Chelation Essay

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Hypogonadism after iron chelation therapy and bone marrow transplantation In chronic iron overload, when transferrin is completely saturated, NTBI is found in the plasma, which is the form of iron that causes toxicity. Intensification of chelation therapy has been shown to reverse cardiac structure and function, but not in the liver. The mechanism proposed was that the heart and also endocrine tissue, including the pituitary gland, take up circulating labile iron species that are non-transferrin-bound iron, while liver iron uptake is mediated via transferrin. Chelation therapy with desferoxamine before the age of puberty has helped patients to attain normal sexual maturation in some studies but not in others. In a study of 40 patients with transfusion-dependent thalassemia major, 90% of 19 patients who began treatment with desferoxamine before the age of 10 had normal sexual development compared with only 38% of those treated after the age of 10 (5). In contrast, another study reported no difference in the frequency of pubertal maturation when iron chelation therapy was started at the age of 10 or earlier (6)]. While serum ferritin levels were still higher than normal in previous studies, a recent study targeted the achievement of normal ferritin levels; 52 …show more content…
Busulfan plus cyclophosphamide and cyclosporine used in transplantation may be responsible for gonadal damage, which was observed primarily in prepubertal girls whereas the same study found no obvious gonadal damage in boys (34)]. It is important to counsel patients on the pros and cons of bone marrow transplantation regarding fertility issues, especially concerning the ovaries, since ovarian failure is a common occurrence (19)]. In contrast, patients undergoing conventional treatment usually have hypogonadotropic hypogonadism, but pregnancy is still possible using hormonal

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