Iron deficiency anemia and iron losses after renal transplantation

Sijie Zheng, Daniel W. Coyne, Heidi Joist, Rebecca Schuessler, Ambyr Godboldo-Brooks, Patrick Ercole, Daniel C. Brennan

Research output: Contribution to journalArticlepeer-review


Iron deficiency contributes to anemia after transplantation. The magnitude of iron loss from blood loss in the peri-transplantation period has not been quantified. We prospectively estimated phlebotomy and surgical losses over the first 12-weeks following transplantation in 39 consecutive renal transplant recipients on hemodialysis (HD), peritoneal dialysis (PD), or chronic kidney disease (CKD). At transplant, ferritin levels were <200 ng/ml in 51% of the patients, and iron saturation was ≤20% in 44%. CKD patients more commonly had ferritin levels <200 ng/ml than either HD or PD patients (100% vs. 21% vs. 67%, P < 0.0002, respectively). Blood loss was similar among HD, PD and CKD patients (833 ± 194 vs. 861 ± 324 vs. 755 ± 79 ml respectively, P = NS), and no difference between deceased and living donor transplant recipients (881 ± 291 vs. 788 ± 162 ml, P = 0.33). Based on baseline hemoglobin (Hgb) of 11.8 g/dl, we estimated that an additional 330 mg of iron was needed to normalize hemoglobin to 13 g/dl, and 605 mg to increase hemoglobin to 14 g/dl. Blood and iron losses over the first 12 weeks post-transplant are substantial and may warrant early administration of intravenous iron.

Original languageEnglish (US)
Pages (from-to)434-440
Number of pages7
JournalTransplant International
Issue number4
StatePublished - Apr 2009
Externally publishedYes


  • Anemia
  • Iron deficiency
  • Renal transplantation

ASJC Scopus subject areas

  • Transplantation


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