The article did not mention the option of not even allowing iron overload to develop in patients who required chronic transfusion. By using treatment via erythrocyte exchange, iron overload with all its sequelae could be prevented without any substantial risk to patients; this has been customary practice in Italy for many years (1). Erythrocyte exchange treatments can be performed in sickle cell anemia, especially in sickle cell crisis, thalassemias, or combined hemoglobinopathies. Erythrocyte exchange treatment can be given from early childhood; it poses no risk of impaired health to the patient further to the risks associated with administering blood products (2).
The cost per year of treatment with deferasirox ranges from €17 872,79 € to 47 207,54; for treatment with deferoxamine from €10 439,07 to 35 798,62 €; and for deferiprone, the amount is €8740.78 (3). By comparison, the costs of erythrocyte exchange—without taking into consideration the erythrocyte concentrates required for transfusion—amount to hundreds of euros, depending on which system is used. This makes erythrocyte exchange treatment a cost effective alternative for therapy with iron chelators, even if the treatment has to be administered monthly.
By means of erythrocyte exchange, secondary hemochromatosis can be prevented in a cost effective way and with a low side effect profile, without exposing the patient to the risk of an additional medication, possibly even at a young age.
Non-invasive quantification of the hepatic iron concentration by means of biosusceptometry (SQUID) is possible. In Germany, this method is currently established only in Hamburg, and the cost is covered by the statutory health insurers, as far as I know.
Footnotes
Conflict of interest statement
The author declares that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
References
- 1.Cabibbo S, et al. Chronic red blood cell exchange to prevent clinical complications in sickle cell disease. Transfus Apher Sci. 2005;32(3):315–321. doi: 10.1016/j.transci.2005.03.003. [DOI] [PubMed] [Google Scholar]
- 2.Velasquez MP, et al. Erythrocytapheresis in children with sickle cell disease and acute chest syndrome. Pediatr Blood Cancer. 2009;53(6):1060–1063. doi: 10.1002/pbc.22211. [DOI] [PubMed] [Google Scholar]
- 3.KBV Wirkstoff AKTUELL; issue 05/2008 [Google Scholar]
- 4.Gattermann N. The treatment of secondary hemochromatosis. Dtsch Arztebl Int. 2009;106(30):449–504. doi: 10.3238/arztebl.2009.0499. [DOI] [PMC free article] [PubMed] [Google Scholar]