Severe hemosiderosis post allogenic bone marrow transplantation

Area of Science:

• Hematology
• Hepatology
• Transplantation

Background:

• Allogeneic bone marrow transplant (BMT) recipients with abnormal liver function typically have diagnoses of chronic graft-versus-host disease (GvHD), viral hepatitis, or drug toxicity.
• These common causes were excluded in a patient presenting with persistent liver dysfunction 15 months post-BMT.

Observation:

• The patient presented with abnormal liver function 15 months after allogeneic BMT.
• Hepatitis serology was negative, and the patient was not on hepatotoxic medications.
• There was no clinical or laboratory evidence of GvHD.

Findings:

• The patient was diagnosed with grade IV hepatic hemosiderosis.
• Despite receiving only 52 units of red blood cells, significant iron overload was present.
• This finding suggests hemosiderosis may occur even with limited transfusion support.

Implications:

• The study postulates that impaired intestinal iron absorption could be a significant factor contributing to hemosiderosis in a subset of allogeneic BMT patients.
• This challenges the assumption that hemosiderosis is solely due to GvHD, viral hepatitis, or extensive blood transfusions.
• Further investigation into intestinal iron absorption post-BMT is warranted to understand and manage this complication.