Highlights from the 67th ASH Annual Meeting: Iron overload still prevalent in SCD patients receiving transfusions

New research presented at the 67th American Society of Hematology (ASH) Annual Meeting in December 2025 found that iron overload continues to be a prevalent problem for individuals with sickle cell disease receiving blood transfusions. The findings suggest a lack of adherence to screening and management guidelines.

“Iron overload has been very clearly linked to morbidity and mortality in other diseases like beta-thalassaemia, but it’s more difficult to untangle these patterns in sickle cell disease, given that transfusions are most frequently given to the sickest patients who are already at higher risk for adverse effects,” said lead study author, Samuel R Wilson, Assistant Professor of Medicine in the Division of Hematology, University of North Carolina School of Medicine, US.

Dr Wilson and his team sought to determine the prevalence of iron overload in individuals with sickle cell disease, as well as comparing screening and diagnostic practices to guideline recommendations. Using 2024 data from the ASH Research Collaborative (ASH RC) Data Hub, they identified 3,723 individuals with a confirmed sickle cell disease diagnosis and sufficient follow-up for analysis.

All study participants were 18 years or older and had at least one year of follow-up. In the absence of liver iron concentration data, the researchers determined iron overload using the lowest annual ferritin value with cut-offs derived from their prior study: Unlikely (ferritin <1000ng/mL or not reported), possible (ferritin 1000-2500ng/mL), or probable (ferritin>2500ng/mL).

“We found that over a quarter of individuals with the HbSS type of sickle cell disease had probable or possible iron overload,” said Dr Wilson. “This is a common problem that needs to be addressed.”

Recent guidelines recommend evaluating for liver iron overload with an MRI of the abdomen rather than measuring ferritin levels, which tend to be less reliable. Abdominal MRIs were obtained in only 27.8 per cent (n=105) of the probable group, 22.9 per cent (75) of the possible group, and 2.7 per cent (82) of the unlikely group.

Additionally, iron chelation was prescribed to only 43.9 per cent (n=166) of those with probable iron overload, 31.7 per cent (n=104) of those with possible, and 2.7 per cent (n=82) of those with unlikely.

“The decision to get a blood transfusion can be very nuanced for individuals with sickle cell disease and data like these can help empower these patients to decide whether it’s the right option for them,” he said.