Abstract:

Anemia of diverse etiology occurs in about 75% of patients with liver cirrhosis. Mucosal injury due to portal hypertension is an underestimated cause of occult bleeding and iron-deficiency anemia. Iron isomaltoside is a parenteral agent with low free-iron toxicity that is used as a short-term infusion without need of test-dose. There are no data on its safety and efficacy in patients with liver cirrhosis.Two males (30 and 66 years old) with Child-A liver cirrhosis and iron-deficiency anemia were evaluated. Both of them had pre-treatment hemoglobin level <90g/l. The older patient once was anti-RBC antibody positive once. No obvious signs and no recent history of blood-loss were established. The first patient had severe portal hypertension: large oesophageal varices with red signs and portal hypertensive gastropathy, while the other one was with significant portal colonopathy, hypertensive gastropathy and medium oesophageal varices. Endoscopic evaluation in both patients showed no active bleeding but marked mucosal friability. Other sources of blood-loss were excluded. Anemia had been previously orallytreated with ferric-hydroxide polymaltose complex, however no improvement was achieved. Both patients were treated with iron isomaltoside infusions. The younger one received a single dose of 1000 mg and after one month Hb levels increased from 80 to 122 g/l. The older subject was treated initially with 600 mg. As a result, Hb levels remained relatively unchanged. A second infusion in a dose of 1200 mg was given amonth later and elevation of Hb from 75 to 95 g/l was achieved. The ferritin rose from 14 to 23 ng/mL. Treatment was well tolerated and no side effects were observed. This is the first report for treatment of iron-deficiency anemia by iron isomaltoside infusion in cirrhotic patients. Further studies are needed to establish its safety and efficacy in subjects with liver cirrhosis.