Upadhyay, BinayakGreen, Steven D.Khanal, NabinAntony, Aśok C.2023-10-312023-10-312021-02-05Upadhyay B, Green SD, Khanal N, Antony AC. Clinical conundrum: managing iron overload after renal transplantation. BMJ Case Rep. 2021;14(2):e239568. Published 2021 Feb 5. doi:10.1136/bcr-2020-239568https://hdl.handle.net/1805/36800Iatrogenic iron overload, which is not uncommon in patients undergoing long-term haemodialysis, arises from a combination of multiple red cell transfusions and parenteral iron infusions that are administered to maintain a haemoglobin concentration of approximately 10 g/dL. Although iron overload due to genetic haemochromatosis is conventionally managed by phlebotomy, patients with haemoglobinopathies and chronic transfusion-induced iron overload are treated with iron-chelation therapy. However, the management of iron overload in our patient who presented with hepatic dysfunction and immunosuppressive drug-induced mild anaemia in the post-renal transplant setting posed unique challenges. We report on the decision-making process used in such a case that led to a successful clinical resolution of hepatic iron overload through the combined use of phlebotomy and erythropoiesis stimulating agents, while avoiding use of iron-chelating agents that could potentially compromise both hepatic and renal function.en-USPublisher PolicyHaematologyLiver diseaseRenal transplantationDialysisArticle