Clinical conundrum: managing iron overload after renal transplantation

• 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
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-239568

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.