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Updated: May 14, 2026

Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Rapid Onset of Iron Overload Cardiomyopathy in Cirrhosis
Cyrus M Nouraee1, William H Swain2, David M Harmon2
1Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Iron overload cardiomyopathy (IOC) can occur in cirrhosis patients without hereditary hemochromatosis. Early diagnosis and iron chelation are crucial for managing this heart failure complication in liver disease.
Area of Science:
- Cardiology
- Hepatology
- Medical Imaging
Background:
- Iron overload cardiomyopathy (IOC) is a rare heart failure cause, typically linked to hereditary or transfusion-related hemochromatosis.
- The occurrence and progression of IOC in cirrhosis patients are not well-documented, despite iron accumulation in cirrhosis.
Abstract:
Iron overload cardiomyopathy (IOC) is a rare cause of heart failure classically associated with hereditary or transfusion-related hemochromatosis. Although iron accumulation occurs in cirrhosis, the development and clinical course of IOC in this population remain poorly described. We report 2 patients with cirrhosis who developed IOC without hereditary hemochromatosis or transfusion-dependent anemia. Patient #1 was a 54-year-old man with alcohol-associated cirrhosis who developed severe cardiomyopathy (left ventricular ejection fraction 23%, 55% 1 year earlier). Patient #2 was a 56-year-old man with cryptogenic cirrhosis who presented with new cardiomyopathy (left ventricular ejection fraction 38%, 71% 9 months earlier). Both patients had elevated ferritin and transferrin saturation, along with reduced myocardial T2∗ relaxation time on cardiac magnetic resonance imaging, consistent with IOC. Both received iron chelation therapy; one patient died, and the other is awaiting combined heart-liver transplantation. These cases highlight IOC as an important consideration in patients with cirrhosis presenting with new cardiomyopathy.
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