TO STUDY EFFECTIVENESS OF DEFERASIROX, AN ORAL IRON CHELATOR IN BLOOD TRANSFUSION DEPENDENT PEDIATRIC THALASSEMIA PATIENTS

Background: Inblood transfusion related thalassemia patients, high iron state is observed because of regular blood transfusion. Our body has limited mechanism to excrete iron, excess of iron gets deposited in various organs causing their dysfunction. To prevent the complication associated with this iron overload use of iron chelators becomes important in management of such patients. Aims /Objectives: 1.To determine effectiveness of deferasirox, an oral iron chelator to decrease iron overload in reference to serum ferritin level in blood transfusion dependent pediatric thalassemia patients. 2.To determine effectiveness of deferasirox in reducing iron deposition induced organ damage. Methods: This is a hospital based retrospective observationalstudy conducted on 80 blood transfusion dependent thalassemia patients admitted in tertiary care hospital. Data was collected in pre-designed case record sheets after taking consent from parents. Results:in the present study the mean age was 7.12 years for females and 10.93 years for males. The mean of pre and post blood transfusion hemoglobin was significantly higher (7.07 and 10.76 respectively). The mean blood transfusion days are 26.33. Mean annual blood requirement is 198.99. Mean drop rate is 1.02. On comparing mean ferritin levels, there was a significant difference between baseline (711.81), start of deferasirox treatment (1271.71) and the end of 2nd dose increment of deferasirox (2076.11). The mean ferritin decreased significantly after starting deferasirox (from 1360.03 to 1271.71) by the end of1stdose increment (from 1832.41 to 1696.75) by the end of 2nd dose increment (from 2097.32 to 2076.11) , but when we compare mean ferritin after end of 2nddose increment of deferasirox (2076.11) with6 month back mean ferritin (2506) or current mean ferritin (2514.90) there is increase in ferritin.Mean blood transfusions at start of deferasirox is (11.025), at 1st dose increment is (26.13), at 2nd dose increment is (42.12).There were no organ complications seen with the present population at the end of the study Conclusion: from the results of our study, we state that using deferasirox as oral iron chelator in blood transfusion dependent pediatric thalassemia patients helps in reducing iron overload till we reach maximum dose of oral deferasirox but beyond that there is significant increase in serum ferritin level,thereby necessitating use of another iron chelator along with oral deferasirox(either deferoxamine, deferiprone or some new iron chelator),. Also in this study it is observed that there is no iron deposition related significant organ damage.