The Mathematics of Iron Overload



The discussion of iron overload goes hand-in-hand with multiple blood transfusions and sickle cell disease so I thought I’d take a moment to discuss what it means to be iron overloaded and why it is so dangerous.

Our bodies absorb about 1mg of dietary iron through our intestines every day and the rest is excreted through urine, sweat and feces. Under normal circumstances, the body absorbs more iron when iron deficient and/or anemic and less when iron overloaded. Through a series of multiple steps the iron makes its way into circulation where a protein called transferrin picks it up and carries it to the bone marrow and liver where it can be used in the making of red blood cells. In most cases, the body easily maintains this delicate balance. For many individuals with sickle cell disease, however, this balance can rapidly become overwhelmed.

In SCD blood transfusions are frequently used to maintain normal hemoglobin levels and to treat many of the side effects of SCD. Transfusions are used to ameliorate the number and severity of crisis in some patients, to drastically decrease the number of strokes in children with SCD and for the treatment and prevention of acute chest syndrome. However, as with most forms of medical intervention, there is a down side…

Now for the math

There are 220 milliliters in every unit of blood (1 unit = 220 mL blood)

Transfusion of packed red blood cells adds 1mg/mL iron (1mL blood = 1mg extra iron)

If a Warrior receives 2 units of blood every 3 months then they will receive 8 units of blood per year.

(8 units) x (220 mL per unit) x (1mg iron per mL) = 1,760 mg of EXTRA elemental iron per year!

Warriors undergoing chronic transfusion therapy receive on average closer to 20 units per year.

(20 units) x (220 mL per unit) x (1mg iron per mL) = 4,400 mgm!

With so much extra iron in the body serum transferrin quickly becomes overwhelmed and cannot transport it all. The extra iron can then deposit in the liver, heart and endocrine organs causing a large amount of damage. Blood transfusions are very beneficial to many individuals with sickle cell disease, but we as Warriors, as a sickle cell community, need to be aware of the inevitable consequences of continuous blood transfusions.

So are you iron-overloaded? Talk to you doctor and make sure.




    • Olade,

      No you should not. If you get blood transfusions, it has iron. This combined with blood transfusions can lead to a great complication called Iron toxicity. So it’s recommended that we stay away from iron. Otherwise you should have foods high in folic acid , like spinach and green leafy vegetables. SCW

  1. Lakiea, i agree totally. Blood transfusion seems to be how sickle cell is treated in the US and unfortunately, the side effects are not discussed much..After about 3 transfusions per year for 3 yrs I had a blood transfusion reaction. Which people can die from. My doctor explained that since blood is donated by people of different races, multiple transfusions, which in LOTS of cases, is not the same race as yours, gradually your body gets antibody after antidoby. Ofcourse there are other factors that generate antibodies, however, No matter how close your blood is matched, you will still get these antibodies with transfusions. The more antibodies you get, the higher you chances of having a reaction and serious iron overload. My health has since deteriorated as i got used to the constant supply so much so that building my own regular supply with no extra transfusion just drains me. I am way more aneamic than i used to be and lets not even speak about the vomitting and migraine i now experience after using any pain meds. I am no longer a candidate for a bone marrow transplant as the transfusions packed me up with numerous antibodies that chances of a rejection will be very high. so my dear warriors, please dont learn the hard way, leave blood transfusions for major surgeries, child birth, etc , not crisis . Eat vegetables and liver, it build your levels rapidly. Doctors have to follow thier gudelines but its your health and you eventually live with the end result. Blood transfusion reactions really makes having sickle cell even more complicated. Please be aware.


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