title: Iron overload in allogeneic hematopoietic stem cell transplant recipients.
abstract: BACKGROUND
  Patients who undergo hematopoietic stem cell transplant are at an increased risk of developing iron overload.
  
  
  OBJECTIVE
  To describe the effect of hepatic iron overload on hematopoietic stem cell transplant recipients and to validate the utility of histologic scoring system of iron granules in the liver.
  
  
  METHODS
  Records of 154 post allogeneic hematopoietic stem cell transplant patients were reviewed. Forty-nine patients underwent liver biopsy. Histologic hepatic iron overload was defined as a score of 2 or greater (scale, 0-4).
  
  
  RESULTS
  Twenty-eight of 49 patients (57%) evaluated by liver biopsy had hepatic iron overload; 17 had moderate to severe hepatic iron overload (score, 3 or 4). In multivariate analysis, a significant correlation was discovered between hepatic iron overload and the number of transfusions (P < .001), posttransplant serum ferritin levels (P=.004), lactate dehydrogenase levels (P=.03), and the development of blood stream infections (P= .02). There was no correlation between hepatic iron overload and abnormal liver function test results. While 37 patients (76%) died after receiving a transplant, mortality was not influenced by hepatic iron overload but was significantly higher in older patients, in patients with lower serum albumin levels, higher serum bilirubin levels, and higher clinical grade of acute graft-versus-host disease (P=.04, P=.001, P=<.001, and P .004, respectively).
  
  
  CONCLUSIONS
  Hepatic iron overload is commonly identified in hematopoietic stem cell transplant patients and can be accurately diagnosed by liver biopsy. In addition, hepatic iron overload has been identified in patients receiving as few as 25 units of packed red blood cells, with elevated posttransplant serum ferritin levels, and with blood stream infections.
authors.affiliation: Departments of Pathology and Laboratory Medicine, Division of Bone Marrow Transplantation, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Sharif
authors.initials: S
authors.lastname: Ali
authors.forename: Jason D
authors.initials: JD
authors.lastname: Pimentel
authors.forename: Javier
authors.initials: J
authors.lastname: Munoz
authors.forename: Veena
authors.initials: V
authors.lastname: Shah
authors.forename: Rick
authors.initials: R
authors.lastname: McKinnon
authors.forename: George
authors.initials: G
authors.lastname: Divine
authors.forename: Nalini
authors.initials: N
authors.lastname: Janakiraman
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006801:Humans; D019190:Iron Overload / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D012189:Retrospective Studies; D014184:Transplantation, Homologous