Nontransferrinbound iron

This is present in plasma in patients with gross iron overload. It is highly toxic, promoting the formation of free radicals causing peroxidation of membrane lipids. Part of the early improvement in liver and cardiac function with chelation therapy may be due to removal of this fraction, even before iron burden is substantially lowered. Its clearance by DFX is short lived as it reappears in plasma within hours of stopping an infusion. This provides a rationale for using 24-h continuous infusions in patients with iron-induced cardiomyopathy. Non-transferrin-bound iron is absent from plasma of well-chelated patients.

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