Abstract
Of the patients who had undergone hemodialysis for 10 or more years, 20 (31%) showed excessive iron due to multiple blood transfusions and excessive oral and parenteral iron administration. A group with excessive iron (20 cases) and one without excessive iron (44 cases) were compared in order to study the relationship between excessive iron administration and osteoarthropathy. In the former group, all 20 patients had serum ferritin concentrations, of 1, 000ng/ml or higher, and 19 cases showed 150μg/dl or higher serum iron concentrations. In this group, the incidence of a carpal tunnel syndrome and pathologic fracture was significantly higher than in the latter group (p<0.05). In the former group with excessive iron, there were no bone findings due to secondary hyperparathyroidism. Bone R-ray and bone scintigram findings revealed low bone metabolism like osteomalacia. The histopathology of synovial membrane and bone was studied in 8 cases. In all the 8 cases, amyloid precipitated, and in 6 cases iron also precipitated. The precipitation of amyloid and iron suggested some relationship. It was likely that, these substances are easily precipitated in low metabolic bone, and the precipitation of amyloid and iron might be a secondary phenomenon. It is certain that in long-term dialysis patients, excessive iron exacerbated osteoarthropathy. In these cases, the low bone metabolism should be improved, and at the same time, careful attention should be paid to blood trassfusion and iron administration. In addition to DFO, the combined use of erythropoietin and exsanguination was thought to be useful for treating patients with excessive iron.
