Acute renal failure following deferoxamine overdose

Area of Science:

• Nephrology
• Hematology
• Pediatric Medicine

Background:

• Iron overload is a common complication in patients with thalassemia syndromes, necessitating iron chelation therapy.
• Deferoxamine is a primary agent for iron chelation, often administered intravenously.
• Sickle cell-beta thalassemia requires careful management of both the hematologic disorder and potential complications like iron overload.

Observation:

• A 17-year-old patient with sickle cell-beta thalassemia self-administered a tenfold overdose of intravenous deferoxamine during home therapy.
• The patient rapidly developed acute renal failure (ARF) within hours of the overdose.
• No long-term nephrotoxic effects were observed after over a year of follow-up.

Findings:

• High-efficiency hemodialysis was initiated immediately following the deferoxamine overdose and ARF diagnosis.
• Renal function promptly returned to baseline after a single session of hemodialysis.
• The patient experienced no residual kidney damage from the acute overdose and subsequent treatment.

Implications:

• Healthcare providers should educate patients and families on the risks of deferoxamine overdose, particularly with home infusion pumps and the need for vigilant monitoring.
• Acute renal failure due to deferoxamine overdose in pediatric patients with sickle cell disease appears to be a reversible condition with timely hemodialysis.
• This case highlights the critical importance of accurate dosing and monitoring in iron chelation therapy to prevent severe adverse events like ARF.