The dangers of iron overload: Bring in the Iron Police


Angela Lambing, MSN, NP-C, Hematology/Oncology, Henry Ford Health System, Detroit, MI 48202. Tel: 313-916-9094; E-mail:


Abstract Purpose: To increase awareness of nurse practitioners (NPs) about the dangers of iron overload and to review common hematologic conditions where transfusions are essential, iron mechanism and transport within the body, effects of iron overload on the body, and treatment options available. Finally, the process for development of a protocol for monitoring such patients will be introduced.

Data sources: Review of existing literature, myelodysplastic syndrome guidelines, sickle cell guidelines, thalassemia guidelines.

Conclusions: Transfusions of packed red blood cells save lives. There are many hematologic conditions for which packed red blood cell transfusions are required as a result of bone marrow suppression. However, extended exposure to red blood cell transfusions places the patient at an additional risk of iron overload. Iron overload is a real concern for patients who become transfusion dependent, with increased risks of liver cirrhosis and cardiac arrhythmias.

Implications for practice: NPs in all areas of practice can increase awareness of the dangers of transfusional iron overload, and become familiar with the treatment options available. Additionally, NPs can institute a monitoring program based on the protocol suggested here within their own practices to prevent poor outcomes for patients with transfusion-related iron overload.