From the Guidelines
Hemosiderin deposits occur primarily due to iatrogenic iron overload in dialysis patients, particularly those receiving blood transfusions and intravenous iron supplements. This condition is characterized by the accumulation of iron in various tissues, including the liver, spleen, adrenal glands, lymph nodes, and lungs, as a result of excessive iron intake 1. The earliest detectable iron deposits are found in cells lining the sinusoids and in Kupffer cells, and as the condition progresses, iron starts to appear in hepatocytes 1.
Key factors contributing to hemosiderin deposits in dialysis patients include:
- Blood transfusions, which increase iron levels in the body
- The use of intravenous iron supplements, such as high-molecular-weight iron dextran, which can lead to massive hepatosplenic siderosis 1
- The duration of dialysis, with patients on dialysis for more than 3 years being at higher risk of developing massive hepatosplenic siderosis 1
The accumulation of iron in tissues can lead to various complications, including organ dysfunction and an increased risk of cirrhosis, particularly in patients with coexisting viral hepatitis 1. However, it is worth noting that liver enzymes are seldom increased in patients with hepatic siderosis, and cirrhosis is rare in the absence of other underlying liver conditions 1.
In terms of management, the use of recombinant human erythropoietin has revolutionized the treatment of anemia and iron overload in dialysis patients, allowing for the simultaneous treatment of both conditions 1. Additionally, non-invasive radiological tools, such as quantitative computed tomography, can be used to diagnose and monitor hemodialysis-associated hemosiderosis 1.
From the Research
Hemosiderin Deposit Causes
- Hemosiderin deposits can occur due to various conditions, including secondary hemochromatosis 2, which is characterized by ineffective erythropoiesis leading to increased duodenal uptake of iron.
- Transfusion-dependent thalassemia can also lead to iron overload, resulting in hemosiderin deposits 3.
- Iron overload can cause organ damage, and iron chelation therapy is used to remove excess iron and prevent further damage 4.
- Sideroblastic anemia, a group of inherited and acquired anemias, can also lead to hemosiderin deposits due to disrupted heme biosynthesis 5.
- Hemosiderin deposits can also occur in recent small subcortical infarcts, and their presence may be associated with infarct volume and small vessel disease score 6.
Conditions Associated with Hemosiderin Deposits
- Secondary hemochromatosis
- Transfusion-dependent thalassemia
- Sideroblastic anemia
- Recent small subcortical infarcts
- Iron overload due to various conditions, including myelodysplastic syndromes and heritable types of severe anemia.
Treatment Options
- Iron chelation therapy to remove excess iron and prevent further damage 2, 3, 4.
- Vitamin B6 supplementation for select cases of X-linked sideroblastic anemia 5.
- Red blood cell transfusions for symptomatic patients with sideroblastic anemia 5.
- Erythroid maturation agents, such as Luspatercept, for the management of anemia in myelodysplastic syndromes subtypes with ring sideroblasts 5.