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Chelation in MDS — RACP Adult Medicine MCQ

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HardHaematologyChelation in MDSRACP Adult Medicine

A 60-year-old man with myelodysplastic syndrome on chronic red cell transfusions (>20 units) has a ferritin of 4000 μg/L. He has cirrhosis secondary to iron overload. He is not a transplant candidate. Oral deferasirox is causing significant GI side effects and AKI. What is the most appropriate alternative?

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Correct answer: C — Deferoxamine infusion

When oral deferasirox is not tolerated, subcutaneous deferoxamine infusion (8–12 hours overnight, 5–7 days/week) is the established alternative for transfusional iron overload. It has been used for decades with proven efficacy. Deferiprone (oral, three times daily) is another alternative. The choice depends on patient tolerance, compliance, and side-effect profile.

Reference: HSANZ – 2024 – Iron Overload in MDS; ELN 2024