MRI T2* is essential for people with transfusional iron overload
Learn more about why and when to get it done.
In patients with transfusion-related iron overload, the two key target organs for iron accumulation are the heart and liver. Although the liver is the major site of iron storage, the smaller amount of iron that goes to the heart can have more serious clinical consequences, including arrhythmias, cardiac failure, and death.
Since serum ferritin and liver iron are not strong predictors of the level of iron deposition in the heart, cardiac iron content should be directly evaluated on a regular basis in patients with transfusion-dependent thalassemia syndromes, in order to determine the risk of iron-related cardiac damage and monitor the effectiveness of the patient’s current chelation regimen in removing excess iron from the heart.
Magnetic resonance imaging (MRI) is currently the preferred method for assessing iron levels in the heart, as it is non-invasive, widely available, and able to measure iron load in a reliable and quantitative manner. The recommended MRI sequence for measuring cardiac iron is T2*, which is inversely correlated with iron content, i.e., the lower the value, the higher the iron level.
Cardiac T2* values 20 milliseconds (ms) or lower indicate clinically significant levels of cardiac iron loading.
Assessment of cardiac iron by MRI T2* should start early in the patient’s life, ideally around age 6 to 10. If an older patient has never previously been evaluated using cardiac MRI, he or she should undergo a baseline scan as soon as possible to help determine his or her risk profile and define the optimal strategy for chelation therapy.
The recommended frequency of ongoing cardiac MRI monitoring will depend on the patient’s degree of cardiac iron overload:
If a patient’s initial scan(s) show(s) heart iron in the normal range, (above 20 ms), follow-up scans should be performed approximately annually thereafter.
Scans should be completed more frequently – every 6 months – in patients at higher cardiac risk due to elevated cardiac iron content (T2* under 10 ms), poor treatment compliance, or reduced left ventricular ejection fraction.
The cardiac T2* sequence can be run on most MRI machines currently in use, provided that the appropriate software has been installed. To find the center nearest you that offers cardiac T2*, enter your address and/or ZIP code into the interactive map.
Centers were identified based on their capacity to perform cardiac T2* monitoring. For your convenience we have also specified the liver imaging services offered by these sites, but it should be noted that this map does not represent a complete listing of centers offering liver iron assessment.
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IMPORTANT SAFETY INFORMATION
What is Ferriprox® (deferiprone)?
Ferriprox® (deferiprone) is a prescription medicine used to treat iron overload from blood transfusions in people with:1
- thalassemia syndromes
- sickle cell disease or other anemias
Ferriprox Tablets are for adults and children ≥8 years of age; Ferriprox Oral Solution is for patients ≥3 years of age.
It is not known if Ferriprox is safe and effective to treat iron overload due to blood transfusions:
- in people with myelodysplastic syndrome or Diamond Blackfan anemia
- in children less than 3 years of age
What is the most important information I should know about Ferriprox?
Ferriprox can cause serious side effects, including a very low white blood cell count. One type of white blood cell that is important for fighting infections is called a neutrophil. If your neutrophil count is low (neutropenia), you may be at risk of developing a serious infection that can lead to death. Neutropenia is common with Ferriprox and can become severe in some people. Severe neutropenia is known as agranulocytosis. If you develop agranulocytosis, you will be at risk of developing serious infections that can lead to death.
Your healthcare provider will do a blood test before you start Ferriprox and regularly during treatment to check your neutrophil count. If you develop neutropenia, your healthcare provider should check your blood counts every day until your white blood cell count improves. Your healthcare provider may temporarily stop treatment with Ferriprox if you develop neutropenia or infection.
Stop taking Ferriprox and call your healthcare provider or get medical help right away if you develop any of these symptoms of infection: fever, sore throat or mouth sores, flu-like symptoms, or chills and severe shaking.
It is important for you to have your white blood cell count checked within 24 hours of developing symptoms of an infection to see if you have severe neutropenia (agranulocytosis). Do not delay getting medical care if you are unable to reach your healthcare provider.
What is Ferriprox® (deferiprone)?
Ferriprox® (deferiprone) is a prescription medicine used to treat iron overload from blood transfusions in people with:1
- thalassemia syndromes
- sickle cell disease or other anemias
Ferriprox Tablets are for adults and children ≥8 years of age; Ferriprox Oral Solution is for patients ≥3 years of age.
It is not known if Ferriprox is safe and effective to treat iron overload due to blood transfusions:
- in people with myelodysplastic syndrome or Diamond Blackfan anemia
- in children less than 3 years of age
Do not take Ferriprox if you are allergic to deferiprone or any of the ingredients in Ferriprox.
Before you take Ferriprox, tell your healthcare provider about all of your medical conditions, including if you: have liver problems, are pregnant or plan to become pregnant. Ferriprox can harm your unborn baby. You should avoid becoming pregnant during treatment with Ferriprox. Tell your healthcare provider right away if you become pregnant or think you may be pregnant during treatment with Ferriprox. For females who are able to become pregnant, your healthcare provider should do a pregnancy test before you start treatment with Ferriprox. You should use effective birth control during treatment with Ferriprox and for at least 6 months after the last dose. For males with female partners who are able to become pregnant, you should use effective birth control during treatment with Ferriprox and for at least 3 months after the last dose. Talk to your doctor if you are breastfeeding or plan to breastfeed. It is not known if Ferriprox passes into your breast milk. Do not breastfeed during treatment with Ferriprox and for at least 2 weeks after the last dose.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements.
Avoid drinking alcohol during treatment with Ferriprox tablets (2 times a day). This may cause a faster release of the medicine.
What are other possible side effects of Ferriprox?
Ferriprox can cause serious side effects, including increased liver enzyme levels in your blood. Your healthcare provider should do blood tests to check your liver function before you start and then monthly during treatment with Ferriprox. Your healthcare provider may temporarily stop treatment with Ferriprox tablets if you develop increased liver enzyme levels and they continue to be increased.
Ferriprox can cause decreased levels of zinc in your blood. Your healthcare provider will do blood tests to check your zinc levels before you start and during treatment with Ferriprox and may prescribe a zinc supplement for you if your zinc levels are low.
The most common side effects of Ferriprox in people with thalassemia include nausea, vomiting, stomach-area (abdominal) pain, joint pain, abnormal liver function tests and low white blood cells.
The most common side effects of Ferriprox in people with sickle cell disease or other anemias include fever, stomach-area (abdominal) pain, bone pain, headache, vomiting, pain in arms or legs, sickle cell anemia with crisis, back pain, abnormal liver function tests, joint pain, mouth and throat pain, common cold, low white blood cells, cough and nausea.
Ferriprox may cause a change in urine color to reddish-brown. This is not harmful and is expected during treatment with Ferriprox.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see Full Prescribing Information, including boxed WARNING, and Medication Guide.
IMPORTANT SAFETY INFORMATION
What is Ferriprox® (deferiprone)?
Ferriprox® (deferiprone) is a prescription medicine used to treat iron overload from blood transfusions in people with:1
- thalassemia syndromes
- sickle cell disease or other anemias
Ferriprox Tablets are for adults and children ≥8 years of age; Ferriprox Oral Solution is for patients ≥3 years of age.
It is not known if Ferriprox is safe and effective to treat iron overload due to blood transfusions:
- in people with myelodysplastic syndrome or Diamond Blackfan anemia
- in children less than 3 years of age
What is the most important information I should know about Ferriprox?
Ferriprox can cause serious side effects, including a very low white blood cell count. One type of white blood cell that is important for fighting infections is called a neutrophil. If your neutrophil count is low (neutropenia), you may be at risk of developing a serious infection that can lead to death. Neutropenia is common with Ferriprox and can become severe in some people. Severe neutropenia is known as agranulocytosis. If you develop agranulocytosis, you will be at risk of developing serious infections that can lead to death.
Your healthcare provider will do a blood test before you start Ferriprox and regularly during treatment to check your neutrophil count. If you develop neutropenia, your healthcare provider should check your blood counts every day until your white blood cell count improves. Your healthcare provider may temporarily stop treatment with Ferriprox if you develop neutropenia or infection.
Stop taking Ferriprox and call your healthcare provider or get medical help right away if you develop any of these symptoms of infection: fever, sore throat or mouth sores, flu-like symptoms, or chills and severe shaking.
It is important for you to have your white blood cell count checked within 24 hours of developing symptoms of an infection to see if you have severe neutropenia (agranulocytosis). Do not delay getting medical care if you are unable to reach your healthcare provider.
What is Ferriprox® (deferiprone)?
Ferriprox® (deferiprone) is a prescription medicine used to treat iron overload from blood transfusions in people with:1
- thalassemia syndromes
- sickle cell disease or other anemias
Ferriprox Tablets are for adults and children ≥8 years of age; Ferriprox Oral Solution is for patients ≥3 years of age.
It is not known if Ferriprox is safe and effective to treat iron overload due to blood transfusions:
- in people with myelodysplastic syndrome or Diamond Blackfan anemia
- in children less than 3 years of age
Do not take Ferriprox if you are allergic to deferiprone or any of the ingredients in Ferriprox.
Before you take Ferriprox, tell your healthcare provider about all of your medical conditions, including if you: have liver problems, are pregnant or plan to become pregnant. Ferriprox can harm your unborn baby. You should avoid becoming pregnant during treatment with Ferriprox. Tell your healthcare provider right away if you become pregnant or think you may be pregnant during treatment with Ferriprox. For females who are able to become pregnant, your healthcare provider should do a pregnancy test before you start treatment with Ferriprox. You should use effective birth control during treatment with Ferriprox and for at least 6 months after the last dose. For males with female partners who are able to become pregnant, you should use effective birth control during treatment with Ferriprox and for at least 3 months after the last dose. Talk to your doctor if you are breastfeeding or plan to breastfeed. It is not known if Ferriprox passes into your breast milk. Do not breastfeed during treatment with Ferriprox and for at least 2 weeks after the last dose.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements.
Avoid drinking alcohol during treatment with Ferriprox tablets (2 times a day). This may cause a faster release of the medicine.
What are other possible side effects of Ferriprox?
Ferriprox can cause serious side effects, including increased liver enzyme levels in your blood. Your healthcare provider should do blood tests to check your liver function before you start and then monthly during treatment with Ferriprox. Your healthcare provider may temporarily stop treatment with Ferriprox tablets if you develop increased liver enzyme levels and they continue to be increased.
Ferriprox can cause decreased levels of zinc in your blood. Your healthcare provider will do blood tests to check your zinc levels before you start and during treatment with Ferriprox and may prescribe a zinc supplement for you if your zinc levels are low.
The most common side effects of Ferriprox in people with thalassemia include nausea, vomiting, stomach-area (abdominal) pain, joint pain, abnormal liver function tests and low white blood cells.
The most common side effects of Ferriprox in people with sickle cell disease or other anemias include fever, stomach-area (abdominal) pain, bone pain, headache, vomiting, pain in arms or legs, sickle cell anemia with crisis, back pain, abnormal liver function tests, joint pain, mouth and throat pain, common cold, low white blood cells, cough and nausea.
Ferriprox may cause a change in urine color to reddish-brown. This is not harmful and is expected during treatment with Ferriprox.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see Full Prescribing Information, including boxed WARNING, and Medication Guide.