Monitoring of Deferoxamine-Related Toxicity
| Toxicity . | Investigations . | Frequency . | Alteration in Therapy . |
|---|---|---|---|
| (1) High frequency sensorineural hearing loss | Audiogram | Yearly; if patient symptomatic, immediate reassessment | Interrupt DFO immediately; directly assess body iron burden; discontinue DFO × 6 mo if HIC 3.2-7 mg/g dry weight tissue; repeat audiogram Q3 mo until normal or stable; adjust DFO to HIC as per Table 3 |
| (2) Retinal abnormalities | Retinal examination | Yearly; if patient symptomatic, immediate reassessment | Interrupt DFO immediately; directly assess body iron burden; discontinue DFO × 6 mo if HIC 3.2-7 mg/g dry weight tissue; review Q3 mo until normal or stable; adjust DFO to HIC as per Table 3 |
| (3) Metaphyseal and spinal abnormalities | X-rays of wrists, knees, thoraco-lumbar-sacral spine; bone age of wrist | Yearly | Reduce DFO to 25 mg/kg/d × 4/wk; directly assess body iron burden; discontinue DFO × 6 mo if HIC ≤3 mg/g dry weight tissue; Reassess HIC after 6 mo; adjust DFO to HIC as per Table 3 |
| (4) Decline in height velocity and/or sitting height | Determination of sitting and standing heights | Twice yearly | As in (3) above; Regular (6-monthly) assessment by pediatric endocrinologist |
| Toxicity . | Investigations . | Frequency . | Alteration in Therapy . |
|---|---|---|---|
| (1) High frequency sensorineural hearing loss | Audiogram | Yearly; if patient symptomatic, immediate reassessment | Interrupt DFO immediately; directly assess body iron burden; discontinue DFO × 6 mo if HIC 3.2-7 mg/g dry weight tissue; repeat audiogram Q3 mo until normal or stable; adjust DFO to HIC as per Table 3 |
| (2) Retinal abnormalities | Retinal examination | Yearly; if patient symptomatic, immediate reassessment | Interrupt DFO immediately; directly assess body iron burden; discontinue DFO × 6 mo if HIC 3.2-7 mg/g dry weight tissue; review Q3 mo until normal or stable; adjust DFO to HIC as per Table 3 |
| (3) Metaphyseal and spinal abnormalities | X-rays of wrists, knees, thoraco-lumbar-sacral spine; bone age of wrist | Yearly | Reduce DFO to 25 mg/kg/d × 4/wk; directly assess body iron burden; discontinue DFO × 6 mo if HIC ≤3 mg/g dry weight tissue; Reassess HIC after 6 mo; adjust DFO to HIC as per Table 3 |
| (4) Decline in height velocity and/or sitting height | Determination of sitting and standing heights | Twice yearly | As in (3) above; Regular (6-monthly) assessment by pediatric endocrinologist |