Early Chelation Prevents Cardiac Iron Overload in Diamond–Blackfan Anemia

Infants with Diamond–Blackfan Anemia Syndrome and other congenital marrow failure disorders often require chronic red blood cell transfusions, a life-sustaining therapy that inevitably leads to secondary iron overload [1, 2]. Because the body lacks a physiological mechanism for excreting excess iron, the metal accumulates in vital organs, particularly the liver and heart, where it generates reactive oxygen species that cause progressive cellular damage [3, 4]. While chelation protocols are well-established for older children, the optimal timing for intervention in toddlers remains a clinical challenge, caught between the risks of early-onset organ damage and concerns about drug safety in very young patients [5, 6, 7, 8]. A recent multicenter study from France and Italy now provides critical real-world data on the feasibility, safety, and effectiveness of initiating chelation therapy in transfusion-dependent patients under three years of age.