Monitoring ICT

Assessment of IOL and common adverse events of ICT. Ideal assessments are listed and mandatory assessments bolded.
Observation	Frequency	IOL assessment	AE monitoring
Iron intake rate	Each transfusion	✔
Chelation dose and frequency	3 monthly	✔	✔
Renal function^a	As frequently as required		✔
Liver function	3 monthly	✔	✔
Sequential serum ferritin, transferrin saturation^b	3 monthly	✔
GTT, thyroid, calcium metabolism (BMD^c)	Yearly in adults	✔
Liver iron (T2^* MRI)^d	At baseline where feasible and subsequently as clinically indicated	✔
Cardiac function (echo, MRI, ecg)	At baseline then as clinically indicated	✔
Cardiac iron (T2^* MRI)	For patients receiving >50U RBC prior to ICT, or with CHF or arrythmias	✔
Slit lamp examination, audiometry	Yearly		✔
AE, adverse event; BMD, bone mineral density; CHF, congestive heart failure; ecg, electrocardiogram; echo, echocardiogram; GTT, glucose tolerance test; ICT, iron chelation therapy; IOL, iron overload; MRI, magnetic resonance imaging; RBC, red blood cells; U, units ^acreatinine should be measured at least every two weeks with each dose increase until stable ^btransferrin saturation >80% may indicate the presence of oxidative stress (reference [1]) ^cbased on early/suggestive data in transfusion dependent hemoglobinopathies (reference [2]) ^dup to 25% of hepatic IOL is underestimated by serum ferritin level (reference [3]) Reprinted from Leitch HA. 2014 Canadian Perspectives in Clinical Hematology; 2:4-10, with permission and from Leitch HA, et al; Crit Rev Oncol Hematol. 2017 May;113:156-170 with permission. References: 1. Sahlstedt L, et al. Br J Hematol. 2001;113:836-838. 2. Ezzat H, et al. Blood. 2012;120, abstract 3203. 3. Nolte F, et al. Ann. Hematol. 2013;92:191-198.