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Article |

Hemosiderosis in Hemodialysis Patients

Harold Bregman, MD; Michael C. Gelfand, MD; James F. Winchester, MB, MRCP; James H. Knepshield, MD
JAMA. 1981;246(3):214. doi:10.1001/jama.1981.03320030012011.
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To the Editor.—  The authors of the article "Hemosiderosis in Hemodialysis Patients: An Autopsy Study of 50 Cases" (1980;244:343) failed to emphasize that reticuloendothelial system iron overload without bone marrow iron overload occurred exclusively in those hemodialysis patients who had received iron parenterally. No patient was studied with iron overload caused by excessive oral intake or blood transfusion. Our studies of iron-overloaded hemodialysis patients with muscle iron deposition,1 some of whom received parenteral iron, showed excellent correlation of serum ferritin level with bone marrow iron stores, in contrast to the authors' conclusions.Furthermore, serum ferritin levels are falsely elevated in acute or chronic liver disease.2 The elevated serum ferritin levels in five of their patients, therefore, cannot be interpreted as indicating iron overload, since these patients had chronic liver disease, based on the pathological findings presented.The serum ferritin level, therefore, remains a useful reflection of bone marrow


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