Megaloblastic anemia-related iron overload and erythroid regulators: a case report

• Main Authors: Nicolas Vallet, Jean-Baptiste Delaye, Martine Ropert, Amélie Foucault, Noémie Ravalet, Sophie Deriaz, Thomas Chalopin, Hélène Blasco, François Maillot, Olivier Hérault, Emmanuel Gyan
• Format: Article
• Language: English
• Published: BMC 2021-09-01
• Series: Journal of Medical Case Reports
• Subjects: Vitamin B12; Iron overload; Erythropoiesis; Erythroferrone; GDF15; Case report
• Online Access: https://doi.org/10.1186/s13256-021-03065-0

Abstract Background In ineffective erythropoiesis, hepcidin synthesis is suppressed by erythroid regulators, namely erythroferrone and growth differentiation factor-15. For the first time, the hypothesis that iron overload in megaloblastic anemia may be related to ineffective erythropoiesis is explored by describing the kinetics of hepcidin, erythroferrone, and growth differentiation factor-15 levels in a patient diagnosed with megaloblastic anemia associated with iron overload. Case presentation An 81-year-old Caucasian male was admitted for fatigue. He had type-2 diabetes previously treated with metformin, ischemic cardiac insufficiency, and stage-3 chronic kidney disease. Vitiligo was observed on both hands. Biological tests revealed normocytic non-regenerative anemia associated with hemolysis, thrombocytopenia, and elevated sideremia, ferritin, and transferrin saturation levels. Megaloblastic anemia was confirmed with undetectable blood vitamin B12 and typical cytological findings like hyper-segmented neutrophils in blood and megaloblasts in bone marrow. The patient received vitamin B12 supplementation. At 3 months, biological parameters reached normal values. Hepcidin kinetics from diagnosis to 3 months inversely correlated with those of erythroferrone and growth differentiation factor-15. Conclusions This case suggests that iron-overload mechanisms of dyserythropoietic anemias may apply to megaloblastic anemias.