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Hemosiderosis in hemodialysis patients. An autopsy study of 50 cases
Insights
Hemodialysis patients often experience iron overload in organs like the liver and spleen. Serum ferritin levels may not accurately reflect iron stores in patients with chronic kidney disease.
Area of Science:
- Nephrology
- Hematology
- Pathology
Background:
- Chronic renal disease (CRD) patients undergoing hemodialysis (HD) are at risk of iron overload.
- Iron supplementation is common in CRD, potentially leading to excessive iron accumulation.
Purpose of the Study:
- To investigate the distribution of stainable iron in various organs of hemodialysis patients.
- To assess the relationship between organ iron deposition, bone marrow iron stores, and serum ferritin levels.
Main Methods:
- Histopathological examination of iron stores in organs from 50 hemodialysis patients.
- Assessment of bone marrow iron in a subset of patients.
- Correlation of organ iron distribution with serum ferritin concentrations.
Main Results:
- Massive iron deposits were predominantly observed in the liver and spleen.
- Severe hepatosplenic siderosis was noted in 18 patients, with abundant iron in adrenal glands, lymph nodes, and lungs, but sparse in the heart, kidneys, and pancreas.
- Nineteen patients showed absent or scarce bone marrow iron, with five of these exhibiting high serum ferritin levels, indicating a potential disconnect between serum markers and actual iron stores.
Conclusions:
- Long-term hemodialysis can lead to significant iron overload in multiple organs.
- Severe iron deposition in the liver and spleen can occur even in patients with depleted bone marrow iron.
- Serum ferritin levels may not be a reliable indicator of bone marrow iron status in hemodialysis patients with chronic renal disease.
Abstract:
The distribution of stainable iron stores was investigated in various organs of 50 hemodialysis patients with chronic renal disease. Massive iron deposits were found in the liver and spleen. Among 18 patients with severe hepatosplenic siderosis, iron deposits were abundant in the adrenal glands, lymph nodes, and lungs and were sparse in the heart, kidneys, and pancreas. There was an absence or scarcity of stainable iron in bone marrow of 19 pats. In five of these marrow-iron-depleted patients, serum concentrations of ferritin were high. In long-term hemodialysis patients, a variety of factors make massive iron overloads of various organs a likely occurrence, severe hepatosplenic siderosis may occur in marrow-iron-depleted patients, and serum ferritin levels in this setting may not always accurately reflect the status of marrow iron store.