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Iron overload refractory to phlebotomy in a patient with type 1 hereditary hemochromatosis
Sobrecarga férrica refractaria a flebotomías en un paciente con hemocromatosis hereditaria tipo 1
Marta Canelo-Vilaseca
, Josep-Maria Ribera, Inés Hernández-Rodríguez
Corresponding author
Servicio de Hematología, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Badalona, Barcelona, Spain
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Phlebotomies were initiated, with resistance observed after 19 procedures. Magnetic resonance imaging (MRI) showed a homogeneous and intense decrease of the hepatic signal (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a, and comparison with a patient without iron overload, <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b). MRI calculation showed a significant iron overload (IO) of 361<span class="elsevierStyleHsp" style=""></span>μmol Fe/g (normal values <36<span class="elsevierStyleHsp" style=""></span>μmol Fe/g).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The measurement of iron concentration by MRI through T2 relaxometry nowadays replaces liver biopsy as it is a non-invasive, comfortable, sensitive and specific technique. Iron deposited in the tissues interferes with the hydrogen atoms, altering the normal signal intensity, and the calculation by means of a standardised algorithm provides a reproducible numerical result.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In this case, the patient presented with IO due to hemochromatosis, aggravated by chronic haemolysis due to beta-thalassemia (an added condition that could explain the resistance to phlebotomies). Early diagnosis of IO is important as failure to diagnose it can lead to fibrosis or cirrhosis of the liver.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">No funding was provided for this article.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">Informed consent was obtained for this article.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Informed consent" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 791 "Ancho" => 2020 "Tamanyo" => 130754 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016000000008/v1_202305031634/S2387020623001201/v1_202305031634/en/main.assets" "Apartado" => array:4 [ "identificador" => "51820" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016000000008/v1_202305031634/S2387020623001201/v1_202305031634/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623001201?idApp=UINPBA00004N" ]
