Hilfenhaus M, Koch K M, Bechstein P B, Schmidt H, Fassbinder W, Baldamus C A
Contrib Nephrol. 1984;38:167-74. doi: 10.1159/000408082.
In RDT hemosiderosis appears to be an inevitable complication only in the small number of patients in need of frequent transfusions. To prevent clinical consequences (e.g. cardiomyopathy) known from polytransfused patients without renal disease, transplantation should be considered in RDT patients in need of frequent transfusions. Iron substitution - preferably oral - to replace dialysis-related iron loss does not cause clinically significant hemosiderosis provided iron stores are monitored adequately. A sufficient method of controlling iron stores in RDT patients under iron substitution or regular transfusion therapy is a twice annual determination of serum ferritin concentration. The treatment of choice for hemosiderosis in nontransfused RDT patients is discontinuation of iron substitution. When polytransfused RDT patients with severe hemosiderosis cannot be transplanted and submitted consecutively to phlebotomy, DFO treatment is indicated. Quantitative data regarding optimal dosage and application of DFO in RDT patients are not yet available. Constant infusion of DFO during hemodialysis may be superior to bolus application.
在接受规律透析治疗（RDT）的患者中，铁过载导致的含铁血黄素沉着症似乎仅在少数需要频繁输血的患者中是不可避免的并发症。为预防在无肾脏疾病的多次输血患者中已知的临床后果（如心肌病），对于需要频繁输血的RDT患者应考虑进行移植。通过补铁（最好是口服）来补充与透析相关的铁流失，只要对铁储备进行充分监测，就不会导致具有临床意义的含铁血黄素沉着症。在接受补铁或定期输血治疗的RDT患者中，一种充分控制铁储备的方法是每年测定两次血清铁蛋白浓度。对于未输血的RDT患者，治疗含铁血黄素沉着症的首选方法是停止补铁。当患有严重含铁血黄素沉着症的多次输血的RDT患者无法进行移植且需连续进行放血治疗时，则需使用去铁胺（DFO）治疗。目前尚无关于DFO在RDT患者中的最佳剂量和应用的定量数据。在血液透析期间持续输注DFO可能优于推注给药。
