title: Iron deficiency anemia and iron losses after renal transplantation.
abstract: Iron deficiency contributes to anemia after transplantation. The magnitude of iron loss from blood loss in the peri-transplantation period has not been quantified. We prospectively estimated phlebotomy and surgical losses over the first 12-weeks following transplantation in 39 consecutive renal transplant recipients on hemodialysis (HD), peritoneal dialysis (PD), or chronic kidney disease (CKD). At transplant, ferritin levels were <200 ng/ml in 51% of the patients, and iron saturation was </=20% in 44%. CKD patients more commonly had ferritin levels <200 ng/ml than either HD or PD patients (100% vs. 21% vs. 67%, P < 0.0002, respectively). Blood loss was similar among HD, PD and CKD patients (833 +/- 194 vs. 861 +/- 324 vs. 755 +/- 79 ml respectively, P = NS), and no difference between deceased and living donor transplant recipients (881 +/- 291 vs. 788 +/- 162 ml, P = 0.33). Based on baseline hemoglobin (Hgb) of 11.8 g/dl, we estimated that an additional 330 mg of iron was needed to normalize hemoglobin to 13 g/dl, and 605 mg to increase hemoglobin to 14 g/dl. Blood and iron losses over the first 12 weeks post-transplant are substantial and may warrant early administration of intravenous iron.
authors.affiliation: Department of Internal Medicine, Renal Division, Washington University School of Medicine, St Louis, MO 63110, USA.
authors.forename: Sijie
authors.initials: S
authors.lastname: Zheng
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Coyne
authors.forename: Heidi
authors.initials: H
authors.lastname: Joist
authors.forename: Rebecca
authors.initials: R
authors.lastname: Schuessler
authors.forename: Ambyr
authors.initials: A
authors.lastname: Godboldo-Brooks
authors.forename: Patrick
authors.initials: P
authors.lastname: Ercole
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
mesh_terms: D000328:Adult; D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000209:etiology*; D000998:Antiviral Agents / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D005260:Female; D005293:Ferritins / Q000097:blood; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007165:Immunosuppression Therapy; D007262:Infusions, Intravenous; D007501:Iron / Q000008:administration & dosage / Q000378:metabolism*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000077562:Valganciclovir; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D006454:Hemoglobins; D005293:Ferritins; D007501:Iron; D000077562:Valganciclovir; D015774:Ganciclovir