Abstract
A case of acute renal failure associated with persistent massive hemolysis after insertion of a prosthetic heart valve was reported. Hemofiltration and deferoxamine were successfuly applied for the treatment of transfusional hemosiderosis.
The patient was a 26-year-old female. She underwent radical surgery for an endocardial cushion defect at the age of 14 and a radical operation involving AS and mitral valve replacement at the age of 19. For two years prior to the present admission, she complained of heart failure symptoms. Tricuspid valve replacement and mitral valve patch repair were performed on June 2, 1981. Acute renal failure and massive mechanical hemolysis were observed postoperatively. A large quantity of blood (120 units) was given for six months, and this caused transfusional hemosiderosis. She developed skin pigmentation, liver injury, increase in serum ferritin and marked hemosiderin deposits in the bone marrow. Hemofiltration with intravenous drop infusion of deferoxamine and Vitamin C was performed once a week for seven months. Approximately 20mg of iron per treatment were excreted in the filtrate and urine. Skin pigmentation, liver damage, heart failure and increase in serum ferritin were significantly improved after the treatment.
Transfusional hemosiderosis has been seen occasionally in patients on long-term hemodialysis. Hemofiltration with drip infusion of deferoxamine might be a preferable method of treatment.
