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Severe iron overload and hyporegenerative anemia in a case with rhesus hemolytic disease: therapeutic approach to rare complications
A 33 weeks’ gestation, a baby with rhesus hemolytic disease (RHD), who had received intrauterine transfusions twice, developed cholestatic hepatic disease and late hyporegenerative anemia. Her serum ferritin and bilirubin levels increased to 8842 ng/ml and 17.9 mg/dl, respectively. Liver biopsy showed cholestasis and severe iron overload. Treatment with recombinant erythropoietin (rHuEPO) decreased the transfusion need, and intravenous deferoxamine resulted in a marked decreased in serum ferritin levels and normalization of liver function. In patients who have undergone intrauterine transfusions due to RHD, hyperferritinemia and late hyporegenerative anemia should be kept in mind. Chelation therapy in cases with symptomatic hyperferritinemia and rHuEPO treatment in cases with severe hyporegenerative anemia should be considered.

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Authors: Fatih Demircioğlu, Şule Çağlayan Sözmen, Şebnem Yılmaz, Hale Ören, Nur Arslan, Abdullah Kumral, Erdener Özer, Gülersu İrken

Keywords: Rh hemolitik hastalığı, geç hiporejeneratif anemi, transfüzyona ikincil karaciğer demir birikimi, şelasyon tedavisi

  • Year: 2010
  • Number: 3
  • Referance No: 49469

  • Figure 1. Need for erythrocyte transfusion was decreased with recombinant erythropoietin treatment
  • Figure 2A and 2B. Histological appearance of the liver biopsy. Note the brownish pigment in the hepatocytes in Figure A (H&E staining, x100) consistent with bluish-stained iron in Figure B (Prussia staining, x100)
  • Figure 3. The bilirubin level was normalized with chelation therapy
  • Figure 4. Ferritin values were successfully decreased with chelation therapy

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