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Old Wed May 20, 2009, 11:49 AM
Francine S Francine S is offline
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Join Date: Nov 2008
Location: Tom River, NJ
Posts: 10
Exclamation Iron Overload, Liver and Heart Function

Hello,
It's been some time since I've written about my mother (not sure if my Jan 13 postings are still available). She has MDS (RCMD), has been diagnosed for about a year now (but has had the disease for at least a yr before this) and is 85. She is transfusion dependent (2 units every 2 wks). Her serum ferritin (iron) is in 4000 range. I read in earlier postings that this may not be excessive on the scale of regularly transfused patients but of course requires iron chelation therapy. She was prescribed Exjade, stalled about a month before taking it. After about 13 days of Exjade she voluntarily stopped it because of 2 incidents of diarrhea (1 not too bad, 1 severe). After getting a blood profile, 2 of her 3 liver enzymes were elevated (apologies but I can't find lab results right now!). 1 elevated 2x above Upper Limit Ref Range, the other slightly elevated, the 3rd normal range. Her Hematologist said to stop Exjade for 4 wks and then he'll run another blood profile and see if her liver enzyme levels had decreased. I asked how Exjade could elevate her liver enzymes after just 13 days of use - could it be the iron overload damaging her liver? He would not commet - just said she had to stop the Exjade.
In the meantime, she's had fluid retention in her legs for some time now and was prescribed furosemide (Lasix). She tends to skip 1-2 days/wk for various reasons but last week, did not take it for almost a week. Her legs are terribly swollen, to the point where it's difficult for her to walk. I'm concerned that this is due to a combination of her not being compliant with the diuretic but also that the iron overload is affecting her heart, putting her into some level of heart failure.
I am trying to get a sense of to what extent an iron level in 4000 range can affect liver and cardiac function. Her kidney lab results were normal.
Also I'm wondering if Desferal might be a better option for her than Exjade. Her Hematologist said that Desferal has the same effect on the liver that Exjade does. But at this point, would slightly elevated liver enzymes be better than the side effects of iron in the 4000 range? I'm not clear on what extent Exjade can affect the liver. I've read in other postings on MarrowForums that it has affected kidney function in some MDS patients. Has anyone had this issue of water retention in the legs and/or impaired liver function when taking Exjade? Sorry for this long-winded posting!
Thank you,
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Francine S: My mom, 85 yrs old, prelim diagnosis of MDS ~ June 2007. Nov, 20, 2008 BM biopsy results confirm MDS: RCMD subtype, 3% Blasts, Hypercellular marrow, approx. 70%; no chromosome abberations; transfusion dependent.
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