Improving the Evaluation and Management of Transfusion-Related Iron Overload in Children, Adolescents, and Young Adults Following Cancer Treatment or Hematopoietic Stem Cell Transplantation.
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BACKGROUND: Transfusion-related iron overload (TRIO) is a late effect of therapy impacting survivors of childhood cancer and hematopoietic stem cell transplantation (HSCT) who receive frequent packed red blood cell (pRBC) transfusions. Surprisingly, there are no accepted guidelines to assist providers in identifying and treating at-risk patients. Our primary aim was to create a clinical practice guideline (CPG) for the surveillance of TRIO and measure its impact on care at Helen DeVos Children's Hospital. PROCEDURE: We compared the rates at which screening laboratory and confirmatory imaging studies were obtained 2 years before and 6 months after CPG implementation. We additionally sought to characterize the patients at our institution who developed TRIO. RESULTS: Labs more commonly obtained post-implementation included iron studies such as TIBC (p = 0.0077), TSAT (p = 0.0133), and serum iron (p = 0.0208), and hepatic injury markers such as AST/ALT (p = 0.0278), ALP (p = 0.0073), and total bilirubin (p = 0.0026). Liver MRI/FerriScan (p = 0.0343) and echocardiogram were also more commonly obtained post-implementation. We additionally found a positive correlation between the number of pRBC transfusions and TRIO (p = 0.0025). Gender, age, and weight did not impact the rates of TRIO in either cohort. There was no association between diagnosis category (solid tumor, leukemia/lymphoma, or nonmalignant disease) and TRIO. All patients who developed TRIO received a minimum of 12 months of therapy. CONCLUSIONS: The implementation of a TRIO CPG can significantly influence TRIO screening practices, likely expediting treatment and potentially reducing post-therapy complications.