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The international EPIC study shows that the risks of iron burden may have been underestimated

The study was conducted across 23 countries and recruited 1,744 patients with various transfusion-dependent anaemias

September 29th 2012

Blood Transfusion

One of the risks related to blood transfusion is iron overload, which demands an adequate treatment to prevent serious complications. A recent study published by the the EPIC (Evaluation of Patients' Iron Chelation with Exjade) study investigators, with Vip Viprakasit from the Siriraj Hospital (Bangkok, Thailand) as its first author and Maria Domenica Cappellini from University of Milan (Milan, Italy) as the last, studies the geographical variations in current clinical practice on transfusions and iron chelation therapy. The results, appeared in the Blood Transfusion magazine, show that the risks of iron burden may have been underestimated and current iron chelation therapy, if considered, may not have been adequate to control iron burden. John B. Porter, an ENERCA partner from the University College London (London, United Kingdom), is among the main authors of the article.

Blood transfusion therapy is the cornerstone of management of many patients with chronic anaemias. The EPIC study was conducted across 23 countries and recruited 1,744 patients with various transfusion-dependent anaemias, mainly Thalassaemia Major, Thalassaemia Intermedia, Myelodysplastic Syndromes, Aplastic Anaemia and Sickle Cell Disease. It is a unique opportunity to compare transfusion and chelation practices, in addition to iron burden, across various anaemias and geographical regions.

The results of the study showed that serum ferritin levels were >2,500 ng/mL in a large proportion of patients (~60%). This levels are known to be associated with negative outcomes. It happened even in patients suffering Thalassaemia Major who had received prior chelation for a larger proportion of their lives, possibly due to sub-optimal chelation regimens. Myelodysplastic Syndromes and Aplastic Anaemia patients received transfusion therapy for a smaller proportion of their lifetime than patients with other types of anaemia. However, overall serum ferritin levels still exceeded. In conclusion, although there are several management practice guidelines which include recommendations on transfusion and iron chelation treatment regimens, current practice approaches may not reflect the ideal treatment circumstances.

On the other hand, the study compared results between three wide geographical regions: Europe, Middle East/Africa and Asia-Pacific. It highlighted some differences that could have some implications in clinical practice guidelines. For example, the percentage of Thalassaemia Major patients with a history of hepatitis B and/or C was higher in Europe than in other regions. The number of transfusion sessions for these patients in the year prior to study entry was highest in Europe, and the volume of blood transfused in Europe was higher than in the Middle East/Africa region but slightly lower than in the Asia-Pacific region. Compared with patients in Europe, a larger proportion of patients in the Asia-Pacific region had serum ferritin levels over 4,000 ng/mL.

Overall, these analyses indicate that transfusion and iron chelation practices differ between geographical regions. It is possibly linked to regional variations in specific disease characteristics, treatment practices, availability and accessibility of transfusion and chelation therapy, patients' compliance, physicians' attitudes and adherence to treatment guidelines. To improve standards of clinical practice worldwide there is a need of increased clinical awareness of iron overload and chelation therapy among clinicians and patients.

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