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Kidney Week

Abstract: PO1125

Iron Overload in ESRD Treated with Deferoxamine for Chelation

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Author

  • Barnes, Sylvester, Loyola University Health System, Maywood, Illinois, United States
Introduction

The patient is a 23-year-old female with a history of sickle cell disease, uncontrolled hypertension, and ESRD on HD 3x week for the past 4 years, requiring extensive blood transfusions from hemolysis. Due to the patient’s uncontrolled hypertension epoetin alfa was withheld for a few months. The patient presented to Loyola with severe symptomatic anemia, and concerns for iron overload.

Case Description


The patient presented to the hospital with severe anemia and decreased level of consciousness. Labs revealed a Hgb of 5.8g/dl, SBP of 175mmHg, and platelets of 40,000/ml. Hematology was consulted for further evaluation of anemia and thrombocytopenia. Her reticulocyte index was calculated at only 0.10, LDH 206, haptoglobin < 15, with peripheral smear showing no schistocytes or sickles. Iron was 137mcg/dl, transferrin 100, ferritin 4284ng/ml, and iron saturation 98%. Bone marrow biopsy was obtained showing normal cellular marrow for her age and iron laden macrophages. Hgb electrophoresis showed HgS 3.3% indicating that most of the patient’s blood was transfused blood volume. Epoetin alfa was restarted and chelation therapy was recommended by hematology for iron overload. The patient was started on deferoxamine 50 mg/kg three times per week following hemodialysis. Most recent labs obtained show a ferritin level decreased to 2378ng/ml after receiving several doses of deferoxamine for over a month.

Discussion

This represents a unique case of iron overload from sickle cell disease along with ESRD leading to transfusion dependence. The treatment of iron overload was from the chelating agent deferoxamine. Initial repeat ferritin levels indicate favorable treatment response without adverse events to date. There are only a few case reports of chelation therapy being used in ESRD. Most of these cases per literature review have been limited to cases of porphyria cutanea tarda. While no repeat iron levels have been obtained due to patient discharge, initial ferritin levels indicate possible treatment response. No adverse side effects have been noted with the patient receiving chelation therapy during her hospital admission.