Treatment of a patient with end-stage renal disease, severe iron overload and ascites by weekly phlebotomy combined with recombinant human erythropoietin.
A 41-year-old hemodialyzed woman developed ascites and was found to have secondary iron overload. The dose of administered iron was approximately 11-12 g, and her serum ferritin level was 15,000 ng/ml (15,000 micrograms/l). There were no signs of congestive heart failure, fluid overload, or liver cirrhosis. A program of weekly phlebotomy combined with recombinant human erythropoietin (rhEPO) therapy was tried to eliminate the iron congestion. After 9 months of this therapy, about 5 g of iron had been removed. The ascites completely disappeared, and her serum ferritin level fell to 5,800 ng/ml (5,800 micrograms/l). This suggests that such combined therapy would be useful when iron overload must be corrected rapidly. Before therapy, the sterile ascitic fluid showed exudative characteristics with 3.7 g/dl (37 g/l) of total protein. The serum-ascites albumin difference was 0.6 g/dl (6 g/l), and the fluid contained 1,400 inflammatory cells/mm3 (1.4 X 10(9)/l). Notably, the serum-ascites albumin difference increased in parallel with iron elimination. These findings suggested that iron deposition may have played a role in changing the permeability of the peritoneum, or in impairing lymphatic drainage, both of which are presumed to be pathogenetic factors of nephrogenic ascites.
Nomura
S
S
Department of Medicine, Kawasaki Medical School, Okayama, Japan.
Osawa
G
G
Karai
M
M
D000328:Adult; D001201:Ascites / Q000150:complications / Q000628:therapy; D001815:Bloodletting; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006432:Hemochromatosis / Q000097:blood / Q000209:etiology / Q000628:therapy; D006801:Humans; D007501:Iron / Q000097:blood*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D006435:Renal Dialysis / Q000009:adverse effects; D065227:Transfusion Reaction
D004921:Erythropoietin; D007501:Iron