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Case Reports: Iron Overload Without Blood Transfusion in CLL

By: Melissa Steele-Ogus
Posted: Tuesday, June 9, 2020

A common complication of chronic lymphocytic leukemia (CLL) is immune dysfunction, including immunodeficiency and autoimmune disease. As patients with blood cancers may require multiple transfusions, they are also at risk for iron overload. In two rare case studies of autoimmune hemolytic anemia without blood transfusion in CLL, published in Case Reports in Oncology, Mohammad Ali, DVM, MSc, PhD, and Mohamed A. Yassin, MBBS, MSc, both of the Hamad Medical Corporation, Doha, Qatar, consider the role of screening for iron overload in this patient population.

The first patient was a 29-year-old man who presented with anemia. After a drop from 14 to 6 g/dL in hemoglobin levels, he was diagnosed with autoimmune hemolytic anemia and was prescribed steroids. He was diagnosed with CLL a few months later and received six cycles of fludarabine, cyclophosphamide, and rituximab, after which he went into remission. After chemotherapy, his ferritin level was 1,300 μg/L, and MRI revealed a liver iron concentration of 9.8 mg/g dry weight. The patient received 1,080 mg of deferasirox but was switched to another formulation due to gastrointestinal side effects. A repeat MRI at 1 year showed normal liver iron concentration.

The second patient was a 70-year-old man diagnosed with stage 0 CLL. After a drop in hemoglobin level from 12 to 4 g/dL, he was also diagnosed with autoimmune hemolytic anemia and treated with steroids. An MRI revealed a liver iron concentration of 6.2 mg/g dry tissue post-recovery. The patient was treated with 30 mg/kg of deferasirox and had normal liver iron concentration at 6 months.

“Based on our observations, it is logical to screen patients with CLL and autoimmune hemolytic anemia for iron overload, as this will help to avoid the various complications associated with iron deposition in different bodily organs,” proposed Drs. Ali and Yassin.

Disclosure: The authors reported no conflict of interest.



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