Iron Deficiency Anemia After Successful Renal Transplantation

Abstract

In patients with chronic renal failure, renal transplantation improves anemia and the production of erythropoietin. In patients undergoing hemodialysis the administration of recombinant human erythropoietin improves anemia with a decrease in bodily iron stores. Therefore, one would expect a similar decrease after kidney transplantation. We followed the ferric parameters to determine the incidence of iron deficiency anemia in 24 consecutive renal transplant patients for an interval long enough to achieve steady state values of hemoglobin (5.1 +/- 0.8 months). Hematological parameters and serum levels of iron, ferritin and erythropoietin were measured. The patients were divided into 2 groups according to the decrease in serum ferritin: group 1--16 with a decrease in respect to basal values (114 +/- 56 ng./ml.) and group 2--those without modifications (720 +/- 320 ng./ml.). Except for the similar values, group 1 showed greater improvement in anemia (red blood cells 4.3 x 10(6) +/- 1.1 x 10(6) versus 3.7 x 10(6) +/- 1.5 x 10(6)/ml., p < 0.01) and hematocrit index (38.5 +/- 5.2 versus 33.0 +/- 5.1%, p < 0.05). Four patients had microcythemia (mean corpuscular volume 76.6 +/- 1.4 fluid) with lower hemoglobin values than the other patients in group 1 (10.77 +/- 0.42 versus 12.79 +/- 0.42 gm./dl., p < 0.05). Among the 16 patients in group 1, 7 of 8 whose basal serum ferritin was less than 150 ng./ml. achieved ferritin levels of less than 30 ng./ml. In conclusion, our data support that renal transplantation produces a rapid decrease in iron stores and in some cases induces iron deficiency anemia. This fact should be evaluated and treated properly.

Anemia in children after transplantation: etiology and the effect of immunosuppressive therapy on erythropoiesis

“…The etiology of renal anemia that accompanies renal failure is multifactorial, with the most important factor being relative EPO deficiency for a given hemoglobin or hematocrit. Serum EPO levels were expected to normalize after a successful renal transplantation with normal kidney function creating a functional depletion of iron seen with active erythropoiesis (6). However, anemia may persist after transplantation due to multiple causes.…”

“…The etiologies of anemia after transplantation are multifactorial and incompletely studied (Table 2), with iron‐limited anemia as the most common cause of anemia after transplantation. When endogenous erythropoiesis is stimulated after a successful renal transplantation (6), the situation is analogous to exogenous rhEPO‐stimulated erythropoiesis seen pretransplantation. It is likely that both ‘functional’ and ‘absolute’ iron deficiency are observed after successful transplantation.…”

Report Card on Living Kidney Donation

“…Early PTA has been attributed to blood loss at the time of surgery, frequent blood draws, iron depletion (2,4,(6)(7)(8), the persistent effect of uremic toxins (6), low erythropoietin (EPO) levels (6,9,10), EPO resistance (6,(9)(10)(11)(12) and the negative effects of immunosuppression on erythropoiesis (13,14).…”

The Prevalence and Risk Factors of Anemia in Children with Renal Transplant

“…Anemia has a negative impact on long-term outcome in kidney transplant recipients (1,8). Although the presence of anemia is known to be a problem after renal transplantation, there is still not enough data on the prevalence (3,5,9,10). Especially, insuffi cient data on anemia, which was associated with early and long-term transplantation period in children, was reported (4,(11)(12)(13).…”