losartan-potassium and Hemochromatosis

Iron, an essential nutrient, is required for many diverse biological processes. The absence of a defined pathway to excrete excess iron makes it essential for the body to regulate the amount of iron absorbed; a deficiency could lead to iron deficiency and an excess to iron overload and associated disorders such as anaemia and haemochromatosis respectively. This regulation is mediated by the iron-regulatory hormone hepcidin. Hepcidin binds to the only known iron export protein, ferroportin (FPN), inducing its internalization and degradation, thus limiting the amount of iron released into the blood. The major factors that are implicated in hepcidin regulation include iron stores, hypoxia, inflammation and erythropoiesis. The present review summarizes our present knowledge about the molecular mechanisms and signalling pathways contributing to hepcidin regulation by these factors.

Topics: Animals; Bone Morphogenetic Proteins; Cation Transport Proteins; Cell Hypoxia; Erythropoietin; Hemochromatosis; Hepcidins; Humans; Inflammation; Iron; Mice; Signal Transduction; Smad Proteins; Transferrin

Topics: Anemia, Sickle Cell; Biopsy; Complementary Therapies; Diagnosis, Differential; Erythropoietin; Hemochromatosis; Hepatitis C, Chronic; Humans; Iron; Kidney Transplantation; Liver; Metabolic Syndrome; Phlebotomy; Polycythemia; Polycythemia Vera; Porphyria Cutanea Tarda; Postoperative Complications

Twenty five years ago, Finch summarized knowledge gained primarily from studies of normal individuals, patients with hereditary hemolytic anemias, and patients with hemochromatosis [1]. Under conditions of basal erythropoiesis in normal subjects, plasma iron turnover (as an index of marrow erythropoietic response) is little affected, whether transferrin saturation ranges from very low to very high levels. In contrast, the erythropoietic response in individuals with congenital hemolytic anemia, in whom erythropoiesis is chronically raised up to sixfold over basal levels [2], is affected (and limited) by serum iron levels and by transferrin saturation [3]. Patients with hemochromatosis who underwent serial phlebotomy were observed to mount erythropoietic responses of up to eightfold over basal rates, attributed to the maintenance of very high serum iron and transferrin saturation levels in these patients [4], whereas normal individuals were shown to have difficulty providing sufficient iron to support rates of erythropoiesis greater than three times basal rates [5]. These observations led Finch to identify a "relative iron deficiency" state, also known as "functional iron deficiency," which he defined as circumstances in which increased erythron iron requirements exceed the available supply of iron [6]. In another clinical setting, patients undergoing autologous blood donation represent a model for perisurgical blood loss and the erythropoietic response. Insights gained over the last 20 years regarding the relationship between erythropoietin, iron, and erythropoiesis, along with implications for clinical management, will be reviewed.

Topics: Anemia, Hemolytic; Erythropoiesis; Erythropoietin; Hemochromatosis; Humans; Iron; Transferrin

Iron plays an essential role in immunosurveillance, because of its growth promoting and differentiation inducing properties for immune cells and its interference with cell mediated immune effector pathways and cytokine activities. At the same time, iron is crucial for the proliferation of tumour cells and micro-organisms, due to its role in mitochondrial respiration and DNA synthesis. Thus, gaining control over iron homeostasis is of vital importance for the course of an infection or a tumour disease, since increased iron availability or iron overload of the immune system are associated with an unfavourable course of many of these diseases. The most frequent clinical condition demonstrating this interaction of iron and immunity is anaemia of chronic disease (ACD). ACD develops in patients with chronic activation of cellular immunity such as subjects suffering from malignancies, auto-immune disorders or infections. ACD may be seen as an immune driven disease since cytokines and their products cause (i) a diversion of iron traffic into the reticuloendothelial systems, thus limiting the availability of the metal to erythroid progenitor cells for haem biosynthesis, (ii) an inhibition of erythroid progenitor cell proliferation and (iii) blunted production and activity of erythropoietin (EPO). However, ACD may also hold some benefit by reducing iron availability to invading pathogens, thus limiting their growth, and by stimulating cell mediated immune function. The latter can be referred to the correction of an inhibitory effect of iron towards IFN-gamma induced immune effector pathways in macrophages. Whereas ACD can be easily diagnosed based on the characteristic changes of iron homeostasis, therapy of ACD is much more controversial. Where a cure of the underlying disease is impossible, transfusions for rapid correction of haemoglobin levels and human recombinant EPO can be used with varying success. The sole application of iron should be strictly avoided due to promotion of pathogen growth and impairment of immune function.

Topics: Anemia, Hypochromic; Bacterial Infections; Cytokines; Erythroid Precursor Cells; Erythropoietin; Heme; Hemochromatosis; Humans; Immune Tolerance; Immunity, Cellular; Iron; Macrophages; Neoplasms

The triad of hemochromatosis, hepatoma and erythrocytosis is a rare combination. Hemochromatosis is often not recognized until the patient presents with the symptoms of hepatocellular carcinoma and erythrocytosis, and the development of erythrocytosis is an important clue to the under-lying hepatoma. The high serum iron concentration and the high saturation of the iron-binding protein, as well as the typical bone marrow hemosiderin pattern, are important aids in the recognition of hemochromatosis. To date, all patients with this triad have been elderly males. The clinical course is usually one of rapid deterioration and death. The seven previously reported cases have been reviewed and the relationship of the erythrocytosis to the increased production of erythropoietin is discussed.

Topics: Aged; Carcinoma, Hepatocellular; Erythropoietin; Hemochromatosis; Humans; Liver Neoplasms; Male; Middle Aged; Polycythemia

The molecular mechanism that regulates iron homeostasis is based on a network of signals, which reflect on the iron requirements of the body. HFE-related hemochromatosis is characterized by excessive intestinal absorption of dietary iron, in particular cases resulting in pathologically high iron storage in tissues and organs. During childhood, HFE gene homozygosity or heterozygosity manifests exclusively in the form of biochemical abnormalities. Because of their mutual link, bioavailable iron and endogenous erythropoietin (EPO) are indispensable for effective erythropoiesis. We analyzed the impact of p.(His63Asp) polymorphism of the HFE gene on erythropoiesis taking into consideration endogenous EPO production in the developmental age. In the study we performed, we observed a significant, strong and negative correlation between the concentration of EPO, hemoglobin, and red blood cell count. A negative trend was also noted on the impact of iron concentration and transferrin saturation on EPO production. In conclusion, this preliminary study demonstrates an impaired impact of endogenous EPO on erythropoiesis in the presence of increased iron content in carriers of p.(His63Asp) (heterozygotes) variant of the HFE gene in developmental age.

Topics: Adolescent; Amino Acid Substitution; Erythropoietin; Hemochromatosis; Hemochromatosis Protein; Humans; Male; Mutation, Missense; Polymorphism, Genetic

The aim of this study was to determine retrospectively the efficacy of combined therapy using erythropoietin (EPO) and erythrocytapheresis (EA) in patients with hereditary hemochromatosis (HH) who did not tolerate phlebotomy.. Twenty patients (age range, 43-74 years) with genetically confirmed HH had received low-dose EPO (4,000 IU) in accordance to the patient's hemoglobin levels between each EA session. Laboratory parameters including hemoglobin, ferritin, transferrin, and iron were measured at regular intervals.. Anemia did not occur in a single patient and no serious side effects were observed. Combined treatment with EPO and EA was well tolerated, and all 18 patients who suffered from fatigue prior to therapy recovered. Median ferritin values were 678.5 ng/L before treatment and 145 ng/L after treatment.. EA in combination with EPO is safe and effective in treating patients with HH. Prospective studies comparing this therapeutic option to phlebotomy are warranted. J. Clin. Apheresis 32:170-174, 2017. © 2016 Wiley Periodicals, Inc.

Topics: Adult; Aged; Cytapheresis; Erythrocytes; Erythropoietin; Ferritins; Hemochromatosis; Humans; Middle Aged; Retrospective Studies; Treatment Outcome

Current treatment for newly diagnosed patients with hereditary hemochromatosis (HH) and iron overload consist of weekly phlebotomy or less frequent and more personalized erythrocytapheresis. Previous observations during phlebotomy suggest an increase in intestinal iron uptake caused by lowering of hepcidin as a result of intensive bloodletting. It is not known whether such an effect is present or even more pronounced using erythrocytapheresis since a larger amount of iron is extracted per procedure. In this study we aimed to assess the effect of erythrocytapheresis on the course of iron parameters, with special focus on serum hepcidin. We performed a retrospective proof-of-principle observational study, comparing serum iron parameters in 12 males during the depletion phase using either phlebotomy (n = 6) or erythrocytapheresis (n = 6). Decreases in serum ferritin over time were similar for both treatments but more pronounced using erythrocytapheresis when expressed per treatment procedure. Hemoglobin did not change during erythrocytapheresis, whereas during phlebotomy decreased with 10%. Increase of erythropoietin and soluble transferrin receptor and decrease in transferrin saturation were similar for both treatments. Reduction in serum hepcidin was higher (50% versus 25% of initial value) and occurred more early using phlebotomy (10 versus 20 weeks after start). In aggregate, compared to phlebotomy, the less frequent and more personalized erythrocytapheresis leads to a more pronounced decrease in serum ferritin per treatment procedure, without a larger decrease in serum hepcidin. This may be clinically relevant and may prevent an increase in intestinal iron uptake and an ensuing vicious circle of more frequent treatment procedures. J. Clin. Apheresis 31:564-570, 2016. © 2015 Wiley Periodicals, Inc.

Topics: Blood Component Removal; Erythrocytes; Erythropoietin; Hemochromatosis; Hemoglobins; Hepcidins; Humans; Iron; Male; Phlebotomy; Retrospective Studies; Transferrin

A 39-year-old woman with end-stage renal disease, which was maintained on haemodialysis, developed secondary haemochromatosis after receiving blood transfusions and intravenous iron supplementation without sufficient serum ferritin concentration monitoring. The patient received intravenous deferoxamine three times a week, combined with high-dose recombinant human erythropoietin therapy and haemodialysis. After three months, improvements in biochemical indicators and iron overload were noted.

Topics: Adult; Chelating Agents; Erythropoietin; Female; Ferritins; Hemochromatosis; Hemoglobins; Humans; Kidney Failure, Chronic; Recombinant Proteins; Renal Dialysis; Sequence Analysis, DNA; Tomography, X-Ray Computed; Transferrin; Transfusion Reaction; Treatment Outcome

Iron is essential for mammalian metabolism and its cellular concentration is controlled by regulating its acquisition and storage. Haemochromatosis is a condition involving iron overload that is characterised by increased duodenal iron absorption and a progressive accumulation of iron in vital organs. Hepcidin is the main hormone that regulates iron homoestasis and it is secreted by the liver.. We have studied how extended hepcidin administration affects the iron load status, plasma and tissue iron concentration, erythropoiesis and the expression of proteins involved on iron homeostasis in haemochromatotic (Hfe(-/-)) and wild-type mice.. Hepcidin reverted the high plasma iron concentrations in Hfe(-/-) mice to normal values. The high concentration of hepatic iron was not altered in the liver of these Hfe(-/-) mice. Hepcidin administration did not disturb erythropoiesis in either Hfe(-/-) or wild-type mice and likewise, hepcidin did not modify the expression of any protein analysed in the liver, duodenum or spleen of Hfe(-/-) and wild-type mice. These data confirm that hepcidin administration diminishes plasma iron concentrations.. Treatment with sustained doses of hepcidin diminishes plasma iron concentrations in Hfe(-/-) mice.

Topics: Animals; Antimicrobial Cationic Peptides; Blotting, Western; Erythropoiesis; Erythropoietin; Flow Cytometry; Hematocrit; Hemochromatosis; Hemoglobins; Hepcidins; Iron; Liver; Mice; Mice, Knockout

Topics: Aspartate Aminotransferases; Bone Marrow Transplantation; Child, Preschool; Combined Modality Therapy; Erythropoietin; Female; Ferritins; Graft vs Host Disease; Hemochromatosis; Humans; Leukemia, Myeloid, Acute; Liver Function Tests; Myelodysplastic Syndromes; Phlebotomy; Recombinant Proteins

We report the efficacy, tolerability and cost of erythocytoapheresis plus recombinant human erythropoietin (rHuEPO) in three patients with severe hereditary hemochromatosis (HH). Results indicate that this regimen could be a valid therapeutic alternative in complicated HH patients. Its cost, however, limits its use to patients whose clinical conditions prevent a proper phlebotomy regimen.

Topics: Adult; Combined Modality Therapy; Cytapheresis; Erythropoietin; Hemochromatosis; Hemochromatosis Protein; Histocompatibility Antigens Class I; Humans; Iron Overload; Liver Cirrhosis; Male; Membrane Proteins; Middle Aged; Recombinant Proteins; Treatment Outcome

Topics: Anemia, Iron-Deficiency; Darbepoetin alfa; Erythrocyte Indices; Erythrocyte Transfusion; Erythropoietin; Ferritins; Hemochromatosis; Hemoglobins; Humans; Injections, Subcutaneous; Male; Middle Aged; Phlebotomy; Reticulocyte Count

Topics: Animals; Antimicrobial Cationic Peptides; Biological Transport; Cation Transport Proteins; Enterocytes; Erythropoiesis; Erythropoietin; Gene Expression Regulation; Hemochromatosis; Hemochromatosis Protein; Hepatocytes; Hepcidins; Histocompatibility Antigens Class I; Homeostasis; Iron; Iron Regulatory Protein 1; Iron Regulatory Protein 2; Membrane Proteins; Mice; Models, Biological; Mutation; Nitric Oxide; Oxygen; Response Elements; Signal Transduction; Transcription, Genetic

We describe the case of a 36-year-old woman with hereditary hemochromatosis (HH) resulting in end-stage cardiomyopathy and treated successfully with orthotopic cardiac transplantation. Before and after transplantation, the patient underwent aggressive treatment with frequent phlebotomy. We used erythropoietin concomitantly to maintain adequate hematocrit to support continued phlebotomy. We believe that aggressive use of phlebotomy provided the patient hemodynamic benefit and hastened the return of endocrine function post-transplantation. We also believe that the patient's history of high-dose vitamin C usage may have accelerated iron deposition in the heart and other vital organs.

Topics: Adult; Ascorbic Acid; Cardiomyopathies; Combined Modality Therapy; Contraindications; Erythropoietin; Female; Heart Transplantation; Hemochromatosis; Humans; Phlebotomy

Topics: Adult; Combined Modality Therapy; Drug Evaluation; Erythropoietin; Folic Acid; Hemochromatosis; Hemochromatosis Protein; Histocompatibility Antigens Class I; HLA Antigens; Humans; Male; Membrane Proteins; Middle Aged; Mutation, Missense; Phlebotomy; Recombinant Proteins

A 33 year-old female patient presented with apparent skin pigmentation, sustained liver dysfunction and impaired glucose tolerance. She had received blood transfusions totalling more than 40,000 ml for myelodysplastic syndrome and an allogeneic bone marrow transplant from her HLA-matched sister at the age of 31. Ferrokinetic data showed a significant iron overload. Magnetic resonance imaging suggested excessive iron deposition in the liver. The patient was diagnosed as having secondary hemochromatosis. She was given subcutaneous injections of 6,000 units of recombinant human erythropoietin initially twice a week and then weekly, and phlebotomies were performed to maintain her hemoglobin level above 10 g/dl. Three years later, the total volume of phlebotomized blood reached 24,000 ml, and her ferrokinetic data, serum transaminase levels, glucose tolerance and skin color were significantly improved.

Topics: Adult; Bone Marrow Transplantation; Erythropoietin; Female; Hemochromatosis; Humans; Myelodysplastic Syndromes; Phlebotomy; Recombinant Proteins; Transfusion Reaction; Transplantation, Homologous; Treatment Outcome

Juvenile hemochromatosis is a rare genetic disorder that causes iron overload. Clinical complications, which include liver cirrhosis, heart failure, hypogonadotropic hypogonadism and diabetes, appear earlier and are more severe than in HFE-related hemochromatosis. This disorder, therefore, requires an aggressive therapeutic approach to achieve iron depletion. We report here the case of a young Italian female with juvenile hemochromatosis who was unable to tolerate frequent phlebotomy because of coexistent ss-thalassemia trait. The patient was successfully iron-depleted by combining phlebotomy with recombinant human erythropoietin.

Topics: Adrenal Cortex Hormones; Adrenal Insufficiency; Adult; Arrhythmias, Cardiac; beta-Thalassemia; Chelation Therapy; Chromosomes, Human, Pair 1; Deferoxamine; Erythropoietin; Estrogen Replacement Therapy; Female; Hemochromatosis; Hemosiderosis; Hormone Replacement Therapy; Humans; Hypogonadism; Liver Cirrhosis; Phlebotomy; Progesterone; Recombinant Proteins

The purposes of this study were to evaluate the tolerance, efficacy and safety of isovolemic erythrocytapheresis (EA) in nonanemic patients with hereditary hemochromatosis (HH), and to assess the usefulness of recombinant human erythropoietin (rHuEPO) associated with EA to reduce treatment duration.. In 10 asymptomatic patients with serum ferritin >400 microg/l, transferrin saturation >50%, and GPT elevation, EA with rHuEPO and folic acid was performed.. Red cell indices, serum ferritin, and other iron metabolism parameters (serum iron, transferrin, and transferrin saturation); GPT and other laboratory data were considerably improved.. This method offers better results in less time than traditional phlebotomy. EA with rHuEPO is an effective therapeutic alternative for patients with HH.

Topics: Adult; Blood Component Removal; Erythrocyte Transfusion; Erythropoietin; Hemochromatosis; Humans; Male; Middle Aged; Recombinant Proteins

Topics: Aged; Erythropoietin; Female; Glomerulonephritis; Hemochromatosis; Hemoglobins; Humans; Kidney Failure, Chronic; Kidney Transplantation; Recombinant Proteins; Transferrin

A patient with diabetes mellitus caused by secondary hemochromatosis was treated using recombinant human erythropoietin and phlebotomy. A total of 12 g of iron had been infused in the patient because of iron deficiency anemia. Blood glucose level was 17.3 mmol/L, and hemoglobin A1c level was 9.0% at admission. He was treated using phlebotomy (400 mL per week), along with subcutaneous injection of 3,000 U of recombinant human erythropoietin three times a week. After approximately 100 days, a total of 5,500 mL of blood (2.75 g iron) could be removed. Serum ferritin level decreased from 10,000 micrograms/L to 4,807 micrograms/L. Fasting and maximum serum C-peptide immunoreactivity values during 100-g oral glucose tolerance tests were improved from 0.14 nmol/L to 0.42 nmol/L and from 1.84 nmol/L to 2.61 nmol/L, respectively. This case suggests that pancreatic beta-cell recovers in diabetes caused by hemochromatosis by reducing iron overload during a short period.

Topics: Aged; Blood Glucose; C-Peptide; Combined Modality Therapy; Diabetes Mellitus; Erythropoietin; Ferritins; Hemochromatosis; Humans; Iron; Iron Overload; Islets of Langerhans; Male; Phlebotomy; Recombinant Proteins

Different response patterns to recombinant human erythropoietin (rHuEpo) administration to anemic patients with myelodysplastic syndromes (MDS) are described. The biology of rHuEpo effect on erythropoiesis in patients with MDS has not been elucidated. However, until more biological information is obtained, it could be prudent to consider these response patterns as guidelines in the treatment of MDS. In the small but interesting series of nine patients with MDS only one responded to rHuEpo within the treatment period of eight weeks. Two additional patients continued the treatment on their own, and after 16 weeks a response was noted for the first time. A third patient was treated for only six weeks and a delayed response was recorded while off treatment for ten weeks. This response was also recorded 16 weeks from treatment initiation-as in the other two patients. A fourth patient with MDS developed transfusion related hemosiderosis and during iron chelation therapy the RBC transfusion rate dropped to a rate lower than the rate needed before the rHuEpo treatment. It is emphasized that in non responders, non-routine approaches should be considered.

Topics: Aged; Aged, 80 and over; Anemia, Refractory; Anemia, Sideroblastic; Blood Transfusion; Chelation Therapy; Combined Modality Therapy; Deferoxamine; Erythrocyte Count; Erythropoietin; Female; Follow-Up Studies; Hemochromatosis; Humans; Male; Myelodysplastic Syndromes; Primary Myelofibrosis; Recombinant Proteins; Remission Induction; Transfusion Reaction; Treatment Outcome

Limited red blood cell (RBC) regeneration often prevents collection of sufficient blood from autologous donors. We studied the effects of subcutaneous recombinant erythropoietin (rEPO) in subjects making frequent blood donations. Six healthy iron-replete male subjects took rEPO (200 U/kg) subcutaneously daily, and donated blood (450 mL) twice a week for 3 weeks. During a control study, these subjects also attempted twice-weekly blood donations without rEPO. Four other males given rEPO, including one with idiopathic hemochromatosis, waited until day 8 to begin blood donations. All healthy subjects took oral ferrous sulfate. Subcutaneous rEPO given with blood donations resulted in a marked reticulocytosis (mean peak value 568 +/- 159 x 10(9)/L v 235 +/- 77 x 10(9)/L, control study; P < .05), and enhanced RBC production at 28 days (1,208 +/- 227 mL v 719 +/- 161 mL, P < .05). rEPO in advance of blood donations was slightly less effective in normal subjects (941 +/- 139 mL, P < .05); however, the subject with hemochromatosis produced substantially more RBCs (1,764 mL) than any normal subject. rEPO-treated normal subjects (but not the rEPO-treated patient with hemochromatosis or untreated controls) produced iron-deficient RBCs with elevated zinc protoporphyrin levels and low hemoglobin content. These cells appeared within 1 week of rEPO administration and before laboratory confirmation of depleted iron stores. Thus, subcutaneous rEPO is an effective stimulant of erythropoiesis in nonanemic blood donors. However, in addition to eventual depletion of iron stores, early functional iron deficiency affects response to the drug.

Topics: Blood Donors; Erythrocyte Count; Erythrocyte Indices; Erythropoiesis; Erythropoietin; Ferritins; Ferrous Compounds; Folic Acid; Hematocrit; Hemochromatosis; Hemoglobins; Humans; Iron; Iron Deficiencies; Male; Recombinant Proteins; Reticulocytes; Transferrin; Vitamin B 12

Topics: Erythropoietin; Hemochromatosis; Humans; Pancytopenia; Recombinant Proteins; Renal Dialysis

Erythropoietin has been proved extremely effective in ameliorating the anemia of chronic renal failure and is currently under intensive investigation. We describe a patient with severe anemia and secondary hemochromatosis due to prosthetic valves, who has been successfully treated with erythropoietin. During 12 months' follow-up, an acceptable hemoglobin level was maintained without any need for blood transfusions; in addition, there was evidence indicating regression of hemochromatosis. This patient illustrates that erythropoietin therapy might prove beneficial for similar cases.

Topics: Anemia, Hemolytic; Aortic Valve; Blood Transfusion; Erythropoietin; Female; Heart Valve Prosthesis; Hemochromatosis; Humans; Middle Aged; Mitral Valve

We studied the feasibility of treating refractory anemia and post-transfusional serious hemochromatosis in a patient undergoing hemodialysis (3x4 h weekly) for fourteen years, with recombinant human erythropoietin (r-HuEPO) associated with blood-letting. Blood transfusion previously received by the patient at a rate of two units of packed red cells every month for nine years was stopped and r-HuEPO (80 U/kg b.w.) was administered i.v. at the end of each hemodialysis. When Hct increased over 30%, approximately 40 ml of blood was removed per hemodialysis session in an attempt to accelerate iron loss. Excellent control of anemia and hemochromatosis was achieved after seven months of treatment. The patient's general condition and skin pigmentation were significantly improved.

Topics: Adult; Anemia, Refractory; Blood Transfusion; Bloodletting; Combined Modality Therapy; Erythropoietin; Female; Hemochromatosis; Humans; Kidney Failure, Chronic; Recombinant Proteins; Renal Dialysis; Time Factors

Serum levels of transferrin receptor and erythropoietin were determined in 2 patients with hereditary hemochromatosis undergoing phlebotomy therapy. The objective of the study was to determine changes in serum transferrin receptor and serum erythropoietin occurring during therapy, and to investigate if such changes could be useful to monitor the therapy. The study showed that serum transferrin receptor, and to a lesser extent serum erythropoietin, may be better parameters than serum ferritin as indicators of when phlebotomy should be discontinued. The most sensitive parameter, however, appeared to be the serum transferrin receptor/ferritin ratio.

Topics: Adult; Biomarkers; Bloodletting; Erythropoietin; Female; Hemochromatosis; Humans; Male; Receptors, Transferrin

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.

Topics: Adult; Ascites; Bloodletting; Erythropoietin; Female; Hemochromatosis; Humans; Iron; Kidney Failure, Chronic; Renal Dialysis; Transfusion Reaction

Topics: Adrenal Gland Neoplasms; Adult; alpha-Fetoproteins; Carcinoma, Hepatocellular; Erythropoietin; Heart Neoplasms; Hemochromatosis; Humans; Hypoglycemia; Iron; Liver; Liver Neoplasms; Lung Neoplasms; Male; Neoplasm Metastasis; Polycythemia; Precancerous Conditions

Topics: Aged; Animals; Biopsy, Needle; Carcinoma, Hepatocellular; Chronic Disease; Erythropoietin; Female; Fluorouracil; Hemochromatosis; Humans; Liver Neoplasms; Male; Mice; Polycythemia

Topics: Carcinoma, Hepatocellular; Erythropoietin; Hemochromatosis; Humans; Liver Neoplasms; Male; Middle Aged; Polycythemia

Topics: Anemia; Anemia, Hemolytic; Anemia, Hypochromic; Anemia, Pernicious; Blood Coagulation; Blood Proteins; Chloramphenicol; Epidemiology; Epoetin Alfa; Erythropoietin; Haptoglobins; Hematologic Diseases; Hematology; Hemochromatosis; Humans; Iron-Dextran Complex; Leukemia; Polycythemia; Thromboplastin; Vitamin B 12