Monitoring
Iron load:
Consistent rising serum ferritin levels or intermittent transfusions given at a volume likely to require chelation (e.g., 6 to 8 transfusions of 15 mL/kg each) should trigger R2 (1/T2) or R2* (1/T2*) MRI assessment of LIC.[37][38] Caution is advised in interpreting serum ferritin level, as it is not a reliable indicator of total body iron burden or as a parameter for the monitoring of chelator activity[40]
Cardiac MRI T2* annually.
Cardiovascular:
MRI for assessment of function (echocardiography with tissue Doppler if MRI not possible) annually
Holter monitoring annually.
Hepatobiliary:
Bilirubin levels and AST/ALT monitoring at each transfusion visit if on deferasirox or if active hepatitis B virus or hepatitis C virus infection; less frequently if on deferoxamine
Hepatitis B virus and hepatitis C virus serology annually.
Renal:
BUN and serum creatinine at each transfusion visit if on deferoxamine or deferasirox
Urinalysis for proteinuria, a toxic effect of deferasirox.
Endocrine:
Thyroid and parathyroid function annually
Bone density annually
Glucose tolerance annually
hGH, testicular, and ovarian function based on age and clinical indication.
Other:
HIV serology annually
Vision and hearing annually if on deferoxamine
Pulmonary function every 2 years.
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