concern regarding exjade

Hi,
I have a concern  Olivia went for her tx yesterday her hgb was a 9.1 she got her tx and she did good. Today her Md called me with her ferritin and it was the same as last month 1019. She is in her 2nd month of Exjade and I'm wondering how will I know if it's working? Is it good that her ferritin didn't go up does that mean its workiing? Any insight will be helpful.
Thanks so much!
Kathleen

Most people are reporting an increase in ferritin after first starting Exjade. One reason is that the starting dosage is usually not the full dosage. The other reason seems to be that Exjade removes iron from tissue first, which takes time to be seen in ferritin results. Olivia's ferritin staying at the same level is a good sign. I wouldn't be concerned even if the next reading showed a higher ferritin level. I have seen it take more than a year for a patient to see a reduction in ferritin while using Exjade, but the second year of use showed a dramatic reduction, with the ferritin dropping by more than half. Patience is needed with Exjade. And always keep in mind that the iron contained in serum ferritin can do no harm, so don't be alarmed by moderate increases. It is the iron in tissue and the free iron in the blood that has to be removed and this is where Exjade is working.

Hi Andy,
Thanks for the reply. I was just wondering what it meant ( that is was the same ) because all I've heard is that it usually goes up first and then down. Does it mean its not pulling the iron out of the organs? That is my concern. Could it really be working in such a short time? I know you may not have answers to these questions I just feel confused. 
Thanks again so much
Kathleen

Kathleen,

There are many variables with each patient. In Olivia's case, she started chelation with no delay so there will not be a high iron load to deal with, so I would not expect much of an increase in ferritin. The initial dosage that a patient can tolerate is also a factor. Some patients start on a very low dose and iron will rise until an effective dose is reached. What is Olivia's body weight and dosage?

Olivia weighs 36.6 lbs as of yesterday when she started she was 35 lbs she taked 375 mg of exjade

Her current dose is closer to a maintenance dose than the dose needed to lower ferritin of 30 mg/kg. (She is currently about 16.6 kg, so 500 mg would be the 30 mg/kg dose). However, since she has not been in a position to get iron overloaded, the maintenance dose may be enough, especially since her ferritin level is barely above 1000.