Using Iron-Chelating Agents in Critically Ill Patients with Iron Overload. Fact or Fiction?

Recently, some evidence has shown that the failure of iron homeostasis may occur in critically ill patients and can lead to iron overload. Elevated ferritin levels as a body iron burden index in critically ill patients may be associated with depressed level of consciousness and greater mortality. However, the necessity of using iron-chelating agents in clinical situation is still unknown for these cases. Theoretically, iron homeostasis can be preserved through checking the serum levels of ferritin, total iron binding capacity (TIBC), free iron and hepcidin as iron overload indices, and even the prescription of iron-chelating agents in critically ill cases in ICU. We suggest that studies to firmly delineate the safety and efficacy of iron-chelating agents such as deferasirox at a right dose in critically circumstances such as sepsis.