Detailed annual iron assessments are determined by quarterly ferritin levels, liver biopsies and dose-dependent urinary iron studies which are performed selectively. The results were compared to liver biopsy and ferritin levels to evaluate consistency of the three measurements of overload in our population. As described elsewhere, this is preceded by a detailed educational program that includes Child Life, Social Services, Psychological and Home Care Services. Young children are started at reduced doses. Continuous intravenous infusion is used for selective patients.
Desferal toxicity is monitored every six months via vision and hearing screening.
Growth is monitored quarterly to check for Desferal-related growth delay. At each transfusion visit, the nurse practitioner, psychologist and pediatrician discuss Desferal use with the family. A record of Desferal dosage is maintained in the chart. Home Desferal and health care service is coordinated by the nurse practitioner. Endocrine Dysfunction Endocrine and growth disturbances occur secondary to the disease, its treatment and iron overload.