PB2048 ACUTE IRON OVERLOAD WITH IRON CARBOXYMALTOSE:CASE REPORT
Authors: M. Çınarsoy, A.K. Güneş, H.E. Gözden
Journal: HemaSphere (2019)

Background: Iron deficiency (ID), with or without anemia, represents a major global health problem afecting more than 2 billions people worldwide. Oral iron treatment always becomes the first choise for the treatment of iron deficiency. An other treatment option is parenteral iron therapy and generally is prefered for patients with oral iron treatment is not effective. But today there is a number of conditions where intravenous iron use is well‐established or increasingly considered as first‐option approach. All these developments in the parenteral iron area show strong probability of increasing use of parenteral iron drugs for anemic patients. Aims: We this case report we aim to share our clinical case in a rare sitution Methods: Case report Results: Our patient is 36 years old female and she was diagnosed as iron deficiency anemia in an outpatient clinic. She was treated with ferric carboxymaltose. One month later she was reevaluated her for treatment response and her anemia was treated succesfully but her serum ferritin value was measured as 3500 ng/ml. It was found unusual and she was referred to our clinic for evaluation of hiperferritinemia. We evaluated the patient and no pathological findings were found other than skin brown discoloration. We measured patient's serum ferritin level again and ferritin level was high (3000 ng / ml) as one month before. When we investigated ferric carboxymaltose dose, we saw that in contrast to the ferric carboxymaltose recommended maximum 2000 mg dose for adult patients, it was administered to the patient at a total dose of 8000 mg in two months period as weekly 1000 mg dose. The patient underwent cardiac T2 ∗ magnetic resonance imaging (MRI), liver T2 ∗ MRI, brain MRI. The patient MRI showed significant increase iron in the liver and spleen, whereas increased iron accumulation in brain and heart was not detected with MRI. Deferasirox was started at a dose of 20 mg / kg / day. The ferritin level decreased to 1600 ng / mL from 3000 mg/mL level at the second treatment week with iron chelation therapy. Patient's skin color was not changed significantly. We decide to continue until the serum ferritin value decreases below 1000 ng/mL. 6 months after deferasirox treatment ferritin levels go down step by step and reached to 700 ng/L level. We repeated liver T2 ∗ MRI and there is significant reduction in liver iron accumulation. And her skin discoloration was decreased. Summary/Conclusion: There is no literature data about overdose of ferric carboxymaltose case. We found only two postmarketing adverse case report of national pharmaceutical agencies. First case is a hypophosphatemic osteomalacia case resulted from 8000 mg ferric carboxymaltose usage in 4 month period. The second case is from in France. Ferric carboxymaltose,18000 mg total cumulative dose in six months is received and presented as movement disorder complication. It was reported that iron chelation therapy partially alleviates gait disturbance and relieves it from the dependency on the bed which emerged in the first period in this case. According to these data, first step in ferric carboxymaltose overdose cases;it should be aimed to prevent the development of neurological complications and bone complications. The best way of to prevent these complications can be done with rapid beginning iron chelation therapy. Our case is the first reported case in our country and third case report in the world.