Ferrous sulfate
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Ferrous sulfate Erosive gastritis and other toxicities resulting in gastrointestinal bleeding and worsening of anaemia: case report
A 71-year-old man developed erosive gastritis, corrosive gastric ulcerations and haemosiderosis resulting in GI bleeding and worsening of anaemia during treatment with ferrous sulfate for iron deficiency anaemia. The man, who had a history of chronic kidney disease, coronary artery disease and hypertension, presented for evaluation of persistent anaemia. Based on the evaluation, a diagnosis of iron deficiency anaemia was made. He started receiving empiric treatment with oral ferrous sulfate 325mg tablet twice daily prior to the presentation for anaemia evaluation. After four months of the ferrous sulfate initiation, his colonoscopy and oesophagogastroduodenoscopy were normal. A video capsule endoscopy showed few small bowel angiodysplasias. His Hb and iron studies initially improved on unspecified treatment. Laboratory investigations showed Hb 12.1 g/dL, mean corpuscular volume 85.2 fL, iron saturation 13%, serum ferritin level 81 ng/mL and serum iron level 44 µg/dL. After a few months, he presented with a complaints of dyspnoea, fatigue and melena. At presentation, his HR was 95 and BP was of 100/53 [units not stated]. His Hb level has dropped significantly, and he had mean corpuscular volume 71.1 fL, ferritin 4 ng/mL and iron 6 µg/dL with a 2% iron saturation. The man was treated with two units of packed RBC’s. An upper endoscopy showed a large iron tablet adherent to actively bleeding mucosa in the gastric fundus, with multiple superficial erosions noted throughout the stomach. After removal of the tablet from the gastric wall, an ulcer with bleeding was noted. He was then treated with epinephrine and cauterisation for the ulcer. Pathology of the ulcer showed haemosiderosis due to the erosive iron pill gastritis. The erosive gastritis and corrosive gastric ulcerations resulted in GI bleeding and worsening of anaemia. Eventually, he was discharged on unspecified proton-pump inhibitor therapy. His oral ferrous sulfate was switched to IV ferrous sulfate infusion. Consequently, his Hb levels improved. A repeat esophagogastroduodenoscopy exhibited complete recovery from the fundus ulcer and erosions. Motwani K, et al. Iron pill induced gastritis causing severe anemia. Clinical Journal of Gastroenterology 13: 732-735, 28 May 2020. Available from: URL: http:// doi.org/10.1007/s12328-020-01141-4
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Reactions 21 Nov 2020 No. 1831
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