Clinical conundrum: managing iron overload after renal transplantation

Iatrogenic iron overload, which is not uncommon in patients undergoing long-term haemodialysis, arises from a combination of multiple red cell transfusions and parenteral iron infusions that are administered to maintain a haemoglobin concentration of approximately 10 g/dL. Although iron overload due...

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Bibliographic Details
Published in:BMJ case reports 2021-02, Vol.14 (2), p.e239568
Main Authors: Upadhyay, Binayak, Green, Steven D, Khanal, Nabin, Antony, Aśok C
Format: Article
Language:English
Subjects:
Anemia
Antibodies
Biopsy
Bone marrow
Case Report
Case reports
Clinical decision making
Cytomegalovirus
Decision making
Drug dosages
Enzymes
Erythrocyte Transfusion
Female
Gastrointestinal surgery
Hematinics - administration & dosage
Hemodialysis
Hemoglobin
Hepatitis
Humans
Iron
Iron - administration & dosage
Iron Overload - diagnosis
Iron Overload - etiology
Iron Overload - therapy
Kidney diseases
Kidney Transplantation
Liver
Liver diseases
Liver Function Tests
Magnetic Resonance Imaging
Middle Aged
Obesity
Patients
Phlebotomy
Physiology
Risk Factors
Transplants & implants
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Summary:Iatrogenic iron overload, which is not uncommon in patients undergoing long-term haemodialysis, arises from a combination of multiple red cell transfusions and parenteral iron infusions that are administered to maintain a haemoglobin concentration of approximately 10 g/dL. Although iron overload due to genetic haemochromatosis is conventionally managed by phlebotomy, patients with haemoglobinopathies and chronic transfusion-induced iron overload are treated with iron-chelation therapy. However, the management of iron overload in our patient who presented with hepatic dysfunction and immunosuppressive drug-induced mild anaemia in the post-renal transplant setting posed unique challenges. We report on the decision-making process used in such a case that led to a successful clinical resolution of hepatic iron overload through the combined use of phlebotomy and erythropoiesis stimulating agents, while avoiding use of iron-chelating agents that could potentially compromise both hepatic and renal function.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2020-239568