Article Text

Download PDFPDF
Clinical conundrum: managing iron overload after renal transplantation
  1. Binayak Upadhyay1,
  2. Steven D Green2,
  3. Nabin Khanal2 and
  4. Aśok C Antony2,3
  1. 1Internal Medicine, AMITA Health Saint Francis Hospital Evanston, Evanston, Illinois, USA
  2. 2Division of Hematology-Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
  3. 3Medicine Service (Hematology-Oncology Section), Richard L Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, USA
  1. Correspondence to Dr Aśok C Antony; aantony{at}iu.edu

Abstract

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.

  • haematology (drugs and medicines)
  • liver disease
  • renal transplantation
  • haematology (incl blood transfusion)
  • dialysis

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Footnotes

  • Contributors BU and SDG contributed significantly to this work and are designated co-first authors. BU and NK prepared the initial draft of the manuscript. NK and SDG contributed equally to patient care, additional literature review and to manuscript revision. ACA supervised patient management, and led efforts in revision, editing and organisation of the manuscript. All authors read and approved the final paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.