Hematologist
CION Cancer Clinics
Chelation therapy for thalassaemia: deferasirox and the alternatives | CION Cancer Clinics
Chelation therapy removes the extra iron that regular transfusions leave in the body. Three medicines do this: deferasirox and deferiprone taken by mouth, and deferoxamine given as a slow injection under the skin. None suits everyone. Your haematologist picks one or a combination based on where the iron sits and how the kidneys and liver cope. This page explains the differences, the checks and the side effects to report. At CION Cancer Clinics, our haematologist cares for anaemia, bleeding, clotting and inherited blood disorders, with ArogyaSri, CGHS and cashless insurance accepted.
BP
Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
17+specialists on panel
15,000+patients treated
35+centres across Telangana & AP
4.8★ / 800+Google rating
On this page
- What does chelation therapy do in thalassaemia?
- How do deferasirox, deferiprone and deferoxamine differ?
- What tests happen before and during chelation?
- Which side effects need a call to the team?
- How do families keep chelation going for years?
- What do families often believe about chelation, and what is true?
- Common questions about chelation therapy
The short answer
What does chelation therapy do in thalassaemia?
Chelation therapy is medicine that grabs the extra iron left behind by blood transfusions, so the body can pass it out in urine or stool. It protects the heart, liver and hormone glands from slow iron damage.
Why it is needed at all
Each transfusion brings iron that the body cannot remove on its own. Without chelation, that iron keeps building up for years without any symptoms. By the time the heart or glands show strain, the damage is harder to undo.
The three medicines in use
Three medicines are used in India and worldwide: deferasirox, deferiprone and deferoxamine, which is also spelt desferrioxamine. Two are taken by mouth. One is given as a slow injection under the skin. Some people take two of them together.
It is a long-term commitment
Chelation usually continues for as long as transfusions do, and often beyond. It works only when taken steadily. Missed weeks let iron climb back. The treating team sets which medicine, how much and how often, and changes it as test results move.
This page names medicines but gives no doses. Never start, stop or change a chelation medicine on your own.Side by side
How do deferasirox, deferiprone and deferoxamine differ?
None of them suits everyone. The choice depends on age, where the iron sits, kidney and liver health, and what a family can manage every day.
Deferasirox
Taken by mouth once a day, as a tablet or a tablet dispersed in water. It is often the first choice for children because it is simple to take.
May not suit
- People with weak kidney function
- People with serious liver disease
Deferiprone
Taken by mouth, usually spread across the day. It is thought to be good at removing iron from the heart, so it is often part of a plan when heart iron is high.
May not suit
- Anyone whose white cell count runs low
- Families who cannot manage regular blood count checks
Deferoxamine
The oldest of the three. It is given as a slow injection under the skin through a small pump, usually overnight on several nights a week. It is also used in a drip when iron in the heart needs urgent attention.
Hard to keep up for years, which is its main drawback.Not sure whether this applies to you?
Ask an oncologistChecks along the way
What tests happen before and during chelation?
Before the first dose
Ferritin, kidney and liver blood tests, and a urine test. Hearing and eye checks are often done too, so later changes can be compared.
In the first weeks
Kidney and liver tests are repeated more often while the body gets used to the medicine. With deferiprone, blood counts are checked frequently.
Every few months
Ferritin is tracked as a trend. The team adjusts the plan if it rises steadily or falls lower than intended.
Once a year or so
MRI of the heart and liver, plus eye and hearing checks, show whether the iron in each organ is coming down.
What to watch for
Which side effects need a call to the team?
What you might notice
What to do
Fever, sore throat or mouth ulcers while on deferiprone
Contact the team the same day for a blood count. Go to emergency or call 108 if unwell.
Stomach upset, loose motions or a rash in the early weeks
Tell the team at the next contact. It often settles, but do not change the dose yourself.
Passing much less urine, or vomiting that will not stop
Call the team the same day. Kidney tests may be needed.
Blurred vision or new trouble hearing
Report it soon. An eye or hearing check is arranged.
Orange or reddish urine on deferiprone
Usually harmless, as iron is leaving the body. Mention it at the visit.
Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
Day to day
How do families keep chelation going for years?
The medicine only works when it is taken steadily. Most families find it is the daily routine, not the side effects, that is the real challenge.
Build it into the day
Tie the medicine to something that happens every day, like breakfast or bedtime. Keep a simple chart on the fridge. For a teenager, a phone reminder they set themselves often works better than a parent asking.
Say so when it is not working for you
If your child refuses the taste, or the overnight pump is not happening, tell the team honestly. There is often another medicine or a different way to take it. Hidden missed doses lead to the wrong changes in the plan.
Cost and schemes
Chelation is a long-running expense. Aarogyasri, PM-JAY, CGHS, ECHS, EHS and some state thalassaemia programmes may cover medicines or tests, and cashless insurance may help. Scheme rules change, so check the current rules before you plan.
What this page cannot tell you
It cannot tell you which medicine suits your child, or how long chelation will take to bring iron down. That depends on the reports, and your haematologist explains it.
Commonly believed
What do families often believe about chelation, and what is true?
"Ferritin has come down, so we can stop the medicine."
A falling ferritin means the plan is working, not that the job is done. Iron can still sit in the heart. Only the treating team should decide to lower or pause chelation.
"Chelation damages the kidneys, so it is safer to avoid it."
Kidney changes can happen, which is why regular tests are done. Caught early, they are usually managed by adjusting the plan. Untreated iron overload causes far more harm to the heart and liver.
"One medicine should suit every child."
Children differ in where iron collects, how their kidneys and liver cope, and what they can take daily. A change of medicine is common and is not a failure.
"Herbal iron cleanses can replace chelation."
No herbal product has been shown to remove transfusion iron in a meaningful way. Some can harm the liver. Tell the team about anything else your child takes.
Did you know
When heart iron is high, doctors sometimes combine two chelation medicines rather than raising one. Each pulls iron from slightly different places in the body, so together they can work faster. Only your haematologist can decide whether a combination suits your child.
Questions we are asked
Common questions about chelation therapy
When does a child with thalassaemia start chelation?
The haematologist starts chelation once iron has built up enough, judged from the number of transfusions received and the ferritin trend. For most children on regular transfusions this happens in the early years. Reference ranges differ between laboratories, so the decision rests on the whole picture, not one result.
Is deferasirox better than deferiprone?
Neither is better for everyone. Deferasirox is simple to take once a day. Deferiprone may clear heart iron well but needs frequent blood count checks. Your haematologist chooses based on where the iron sits, kidney and liver health, and what your child can manage.
What if my child misses a few doses?
Do not double up or change the plan on your own. Carry on as prescribed and tell the team how many doses were missed. An occasional miss matters less than a pattern. If doses are often missed, say so openly, because the team may suggest a different medicine or routine.
Can chelation be stopped after a transplant?
After a successful transplant, transfusions usually stop, but stored iron remains. Removing it may still need chelation or careful blood removal for a time. The transplant centre and haematologist decide this together. CION does not perform transplants but coordinates care with qualified centres.
Does chelation need to continue in adults?
For most adults who still receive regular transfusions, yes. Iron keeps arriving with each unit, so the need to remove it continues. People with non-transfusion-dependent thalassaemia may need it for shorter spells, guided by ferritin and MRI results.
Can chelation medicines be taken in pregnancy?
Most chelation medicines are usually paused during pregnancy, but that decision belongs to the haematologist and the obstetric team. Plan pregnancy with them in advance, so iron can be brought down beforehand. Do not stop the medicine yourself on finding out you are pregnant; call the team straight away.
Are the medicines covered by Aarogyasri or other schemes?
Coverage varies. Some state programmes, PM-JAY, CGHS, ECHS and EHS may cover chelation medicines or related tests, and cashless insurance can help with some costs. Entitlements change, so check the current rules with the scheme or ask the helpline to look into your cover.
How can CION help with chelation?
CION's haematology team can review ferritin trends, kidney and liver tests and MRI reports, and explain whether the current plan fits them. We coordinate tests with qualified centres where needed. Bring every report, a list of doses missed, and any side effects you have noticed.
Your Haematologist
Meet CION's haematologist. One specialist for your blood report and your plan.
Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
Want a specific doctor for your case? Mention them when booking.
Book Free ConsultationBook an appointment with our specialist
Share your name and number — we'll call you back within 30 minutes to schedule your consultation.
Sources
- NHS — Thalassaemia - Treatment
- National Heart, Lung, and Blood Institute — Thalassemia
- NHS — Thalassaemia
- American Society of Hematology — Blood disorders: information for patients
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Iron Overload in ThalassaemiaWhy extra iron harms the organsFerritin Targets and Monitoring in ThalassaemiaHow ferritin results guide the planMRI T2* for Cardiac and Liver IronThe scan that shows heart ironThalassaemia Treatment Cost and Schemes in IndiaWhat schemes may coverThalassaemiaThe full thalassaemia guide
Talk to us
Unsure whether the chelation plan is working?
Share the ferritin and scan reports with us. CION's haematology team will go through them with you. One helpline serves every CION centre.