Others receive slow intravenous infusion by way of a portable, battery-operated pump worn over a period of about eight hours, often at night. Patients can expect to receive up to two grams of Desferal for each unit of blood transfused. Typically, a physician will initiate treatment with one gram, gradually adjusting the dose upward until it reaches no more than three grams a day. Urine samples reveal how much iron the patient is excreting and help the physician adjust the dose of Desferal to maintain negative iron balance. Though Desferal is slow acting removing only 6 to 10 mg of iron per infusion it can maintain negative iron balance even when blood transfusions continue.
Success depends on early initiation of therapy.
If significant iron overload exists before chelation therapy is begun, the patient may succumb to progressive heart disease or fibrosis of the liver. Better timed chelation therapy, begun within two years of the initiation of blood transfusion, can prevent or reverse these diseases. In addition to early initiation of therapy, patient compliance is critical to the success of iron chelation. Some patients discontinue Desferal treatment because of the discomfort of repeated needlesticks, a hypersensitive reaction at the site of infusion, or the regimen's inconvenience. Strong supportive care should be given to encourage patients to continue treatment.