Iron sucrose
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Acute iron intoxication: case report A 16-year-old boy developed acute iron intoxication following treatment with iron sucrose [Venofer]. The boy was admitted with a 15-day history of fatigue, headaches, nausea and pallor; the symptoms had worsened over the last 4 or 5 days. He had hereditary spherocytosis, was receiving monthly blood transfusions and had undergone splenectomy at the age of 5 years. On examination, he had an HR of 80/min, an RR of 20/min, a temperature of 36°C and a BP of 90/60mm Hg. Laboratory investigations revealed the following: haemoglobin level 6.7 g/dL, mean corpuscular volume (MCV) 101fL, mean corpuscular haemoglobin 40.7pg, mean cell haemoglobin concentration 40.2 g/dL, thrombocyte count 381 000/mm3 , WBC count 7900/mm3 with severe haemolysis findings and spherocytes in the peripheral blood smear tests, blood sugar level 107 mg/dL, AST level 191 U/L, ALT level 29 U/L, total bilirubin level 4.6 mg/dL, LDH level 1013 U/L, haptoglobin level < 5.83 mg/dL, serum iron level 437 µg/dL, unsaturated iron-binding capacity 3.52 µg/dL, ferritin 100 000 ng/mL, vitamin B12 level 1080 pg/mL, folic acid level 11.6 ng/mL and negative direct Coomb’s test. The boy received fluids and IV RBC suspension. No cause was identified for his increased haemolysis. An examination of his history revealed that he had presented at a health institute 1 month earlier with fever, fatigue, a haemoglobin level of 8 g/dL and an MCV of 103fL. At that time, he had received fifteen ampoules of IV iron sucrose 100mg in separate doses, which were equivalent to 1500mg of elemental iron. He was diagnosed with iron intoxication and started receiving deferoxamine. His ferritin level subsequently decreased to 59 00 ng/mL on day 2, 17 500 ng/mL on day 4, 5128 ng/mL on day 5 and 1200 ng/mL on day 7. His liver enzymes normalised on day 3 and his bilirubin levels normalised on day 5. Deferoxamine treatment was completed on day 7 and he was discharged. He developed no anaemia and, 5 months after discharge, his ferritin level was 920 ng/mL. Ozdemir ZC, et al. Hereditary spherocytosis with iatrogenic acute iron intoxication. [Turkish]. Cocuk Sagligi ve Hastaliklari Dergisi 53: 132-135, No. 2, Jan 2010 803030568 [Turkish; summarised from a translation] - Turkey
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Reactions 7 Aug 2010 No. 1313
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