Chelation Therapy for Transfusion-Dependent Adults

To the Editor: Brittenham and colleagues recently described the use of the superconducting quantum-interference-device (SQUID) susceptometer for detecting and quantifying iron stores in the liver.¹ In an accompanying editorial,² Finch asked when physicians should begin chelation therapy for patients who require long-term transfusions. The ultimate pathophysiologic consequences of transfusional and hereditary hemochromatosis are similar,³ despite early differences in the distribution of iron between parenchymal and reticuloendothelial cells. Even patients with hypoproliferative anemia inevitably acquire clinical evidence of iron overload. Buja and Roberts⁴ found heavy deposition of iron at autopsy in the hearts of adult patients who had received more than.