Guidelines on haemovigilance of post-transfusional iron overload.

Currently, haematologists working both in haemotherapy and clinical haematology have no guidelines for the management and treatment of patients with post-transfusional iron overload. To address this issue, the Spanish Society of Haematology and Haemotherapy (SEHH) and the Spanish Society of Blood Transfusion (SETS) selected several of their members to develop “Guidelines on Haemovigilance of Post-Transfusional Iron Overload”. The first step consisted in a systematic MEDLINE search that included articles published from 1980 to October 2010 using the search term limits “iron overload”, “iron chelation therapy”, “thalassemia”, “myelodysplastic syndromes”, and “magnetic resonance imaging”. Then, in a face-to-face working meeting held in November 2009, the contents and sections of the guidelines were established, the group coordinators and members were selected, the working method to be followed was defined, and the deadlines were set. The members and group coordinators consisted of a team of experts appointed by the SEHH and the SETS, who were to work in one of five working groups. Overall, each of the five working groups consisted of three to five members (one member could work in more than one working group), and one group coordinator who was responsible for establishing a dialogue between members, and setting deadlines. The purpose of the five working groups was to: (i) define the importance of monitoring iron overload in patients with chronic transfusion dependence; (ii) characterise the target population, i.e. which patients should be monitored and how this monitoring should be carried out; (iii) describe the procedures for monitoring transfusional haemosiderosis, including assessment of ferritin levels, transferrin saturation index, units of packed red blood cell units transfused, and general measures for the care of patients; (iv) define which information mechanisms and alert systems should be put into practice, what information must be recorded in a patient’s transfusion history and how this information can be made accessible to treating physicians and generate a computerised warning system for patients at risk of transfusional haemosiderosis based on the patient’s transfusion history; and (v) describe an action protocol in the case of iron overload (Figure 1). Figure 1 Process of elaboration of this guideline. Once each working group had developed the contents of the five main topics, the information was first sent to the appropriate group coordinator to be revised and approved, and then to the rest of the authors for their approval. Before June 2010, two additional face-to-face working meetings and several videoconferences were held in order to unify concepts and issue final recommendations. The contents of these guidelines are, therefore, divided into five different sections. The purpose is to provide the best recommendations from currently available scientific evidence on the issues raised, thus filling the void in the field of post-transfusional iron overload. Because the clinical benefit of many strategies discussed herein is widely accepted, despite not being supported by high-quality randomised trials, the group of experts agreed that the use of levels of evidence was not compulsory in the present guidelines.