The role of aluminum in the functional iron deficiency of patients treated with erythropoietin: case report of clinical characteristics and response to treatment.
The quantitative variation among patients in their response to erythropoietin can be explained, in part, by factors that can independently cause anemia in patients with end-stage renal disease. Aluminum can blunt the effect of erythropoietin, in part by interfering with iron bioavailability. This inhibitory effect cannot be completely overcome by aggressive ferrotherapy, but can be reversed with aluminum chelation therapy. A patient is described who developed hematological evidence of aluminum excess after being treated with erythropoietin. The biochemical evidence of functional iron deficiency and the response to aluminum chelation therapy support the hypothesis that the inhibitory effect of aluminum on erythropoiesis is mediated by the interference of aluminum with the bioavailability of iron.
Donnelly
S M
SM
Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Smith
E K
EK
D000535:Aluminum / Q000494:pharmacology*; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D001682:Biological Availability; D003676:Deferoxamine / Q000627:therapeutic use; D004920:Erythropoiesis / Q000187:drug effects; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007501:Iron / Q000493:pharmacokinetics; D000090463:Iron Deficiencies; D007676:Kidney Failure, Chronic / Q000628:therapy; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use; D006435:Renal Dialysis
D011994:Recombinant Proteins; D004921:Erythropoietin; D000535:Aluminum; D007501:Iron; D003676:Deferoxamine