Role of Deferiprone in Chelation Therapy for Transfusional Iron Overload in Thalassemia and Other Anemias

Background: Thalassemia and other chronic anemias that necessitate regular blood transfusions are seriously complicated by iron overload. Progressive iron accumulation causes toxic deposits in vital organs, including the liver, heart, and endocrine glands, leading to substantial morbidity and mortality if not treated properly. Deferiprone has been used to eliminate iron in patients with a high iron load or cardiac siderosis. Despite its established usefulness, deferiprone linked to side effects necessitating regular monitoring. Objectives: Is to assess the role of deferiprone in chelation therapy among patients with blood transfusion related iron overload resulting from thalassemia and other chronic anemias. The study specifically evaluates its efficacy in lowering blood ferritin levels as well as its safety profile throughout therapy, giving more proof for its clinical value in real-world practice. Methods: This is a hospital-based prospective observational study. It was conducted between the 1st of September of year 2024 to the 31st of December of year 2025 at Al Hadbaa speciality hospital for haematology and bone marrow transplantation in Mosul city, Republic of Iraq. The study included patients with thalassemia or other chronic anemias who received frequent blood transfusions and were given deferiprone as part of their iron chelation treatment. Additionally, it included patients should have serum ferritin level of 2500 ng/mL or higher indicating iron overload; as well as, the included patients’ age should be between 8 to 65 years, have been on deferiprone on the dose of (75 mg/kg/day) for at least six months and have available baseline and follow-up laboratory data. On the other hand, the study excluded patients with acute infections or inflammatory diseases that alter ferritin levels, patient with specific bone marrow condition such as myelodysplastic syndrome, myelofibrosis, leukemia. Furthermore, the study excluded patients with significant hepatic or renal impairment, patients with known hypersensitivity to deferiprone and those with incomplete clinical or laboratory records. Results: The study includes 88 patients; of them 40 patients were male and 48 patients were females. Male: Female ratio was 1:1.2. The mean age ± standard deviation of the study patients was 20.62 ± 7.11 years. The study found the mean of serum ferritin level was significantly decrease from (7306.86 ± 3459.82) before deferiprone to (6066.64 ± 3062.68) after deferiprone at the first checking and to (4978.18 ± 2407.63) at the second checking. Blood urea was statistically significant difference (lowered) after treatment (P value = 0.048), while no statistically significant difference found after treatment regarding serum creatinine, ALT and AST (P value >0.05) for all of them. As well as, after deferiprone the number of patients with each of pulmonary hypertension, left ventricular hypertrophy (LVH), mitral regurgitation (MR) and systolic dysfunction were significantly decrease (P value <0.001). Moreover, the mean of ejection fraction was also significant elevated (P value <0.001) after deferiprone treatment. Chromaturia was reported by 48 (54.5%) patients, followed by appetite changes was reported among 34 (38.6%) patients and dyspepsia in 30 (34.2%) patients. Lastly, 41 (46.5%) patients of the study participants reported frequent discontinuity and 14 (15.9%) patients reported definitive stop of deferiprone.