Rapid iron loading in a pregnant woman with transfusion-dependent thalassemia after brief cessation of iron chelation therapy.
In general, in women with transfusion-dependent thalassemia, during pregnancy, iron chelation therapy is ceased. We report a splenectomized patient, who was an excellent complier with chelation therapy, who before embarking on a pregnancy showed no evidence of iron overload, with normal cardiac, thyroid function and glucose metabolism. Laboratory findings showed ferritin 67 microg/L, myocardial T(2)* of 34 ms and liver magnetic resonance imaging (MRI) liver iron concentration of 1 mg/g dry weight. She became pregnant by in vitro fertilization in October 2006, delivery occurred in June 2007. She breast fed for 2 months. After 12 months without iron chelation, ferritin was 1583 microg/L. Quantitative MRI showed myocardial T(2)* of 27 ms, that the liver iron concentration had increased to 11.3 mg/g dry weight, indicative of moderate to heavy iron load. This case demonstrates that iron overload can develop rapidly and that physicians caring for patients with transfusion-dependent thalassemia should be particularly alert to any discontinuation of chelation therapy over time.
Farmaki
Kallistheni
K
Thalassaemia Unit, General Hospital of Corinth, Corinth, Greece. stheni@otenet.gr
Gotsis
Efstathios
E
Tzoumari
Ioanna
I
Berdoukas
Vasilios
V
D000328:Adult; D001803:Blood Transfusion; D015913:Chelation Therapy; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D007501:Iron / Q000378:metabolism; D007502:Iron Chelating Agents / Q000627:therapeutic use; D019190:Iron Overload / Q000209:etiology*; D008099:Liver / Q000378:metabolism; D011247:Pregnancy; D013789:Thalassemia / Q000150:complications* / Q000628:therapy; D028761:Withholding Treatment
D007502:Iron Chelating Agents; D005293:Ferritins; D007501:Iron