An aggressive chelation regimen is recommended when liver iron is
greater than 20 mg/g dry weight, or cardiac T2* is less than 20. A
higher—but not a toxic—dose of deferoxamine is recommended.
Intensification of treatment can be accomplished by administering
continuous intravenous deferoxamine (via a central intravenous
line, if possible) in the hospital or in an outpatient/day unit. A
minimum of 72 hours continuous, one to two times a month,
in addition to regular use of subcutaneous deferoxamine has
been recommended to increase iron removal. The continuous
regimen alone may control liver iron concentration but will allow
development of cardiac iron. Intravenous treatment is given at 50
to 100 mg/kg per day (with a maximum dose of 6 g per day). This
regimen should be continued until the ferritin level is less than
2,000 ng/mL on two consecutive occasions. Alternative regimens
include daily intravenous administration of deferoxamine, or
continuous deferoxamine via percutaneous line or an indwelling
venous access device. In all such treatment, high-dose, continuous
treatments require careful monitoring for signs of toxicity.