Gastric Siderosis and Ulceration from Intravenous Iron Supplementation Manifesting as Chronic Upper Gastrointestinal Bleeding: A Case Report and Review of the Literature

Abstract

Iron deficiency is the most common etiology of anemia worldwide and is often managed with varying methods of iron supplementation. Although rare, oral iron supplementation can perpetuate iron deficiency anemia by causing gastric ulceration and upper gastrointestinal bleeding in high-risk populations. However, this complication has not been previously described with intravenous iron supplementation. We present a case of a 63-year-old male with severe iron deficiency anemia on biweekly intravenous iron infusions and weekly packed red blood cell transfusions who presented with melena over several months. Upper endoscopy demonstrated a clean-based gastric body ulcer and nonbleeding gastric varices. Histology of the gastric ulcer was suggestive of iron-induced gastric mucosal injury. This case demonstrates that frequent utilization of intravenous iron and packed red blood cell transfusions may predispose certain patients to the development of iron-induced gastritis and ulceration.

Gastric Siderosis Due to Oral Ferrous Sulfate Supplements

“…2,10 Pattern B occurs with extracellular deposition of iron in the lamina propria 2,10 and is most commonly associated with oral iron supplements and frequent blood transfusions. 2,7,10,11 In pattern C, which is seen in cases of chronic systemic iron overload such as hemochromatosis, iron is deposited in the antral and fundic glandular epithelium. 2,10,11 This case series raises awareness of the potential complications of oral ferrous sulfate supplements to the gastrointestinal system.…”

“…2,7,10,11 In pattern C, which is seen in cases of chronic systemic iron overload such as hemochromatosis, iron is deposited in the antral and fundic glandular epithelium. 2,10,11 This case series raises awareness of the potential complications of oral ferrous sulfate supplements to the gastrointestinal system. Overall, gastric siderosis from iron tablets is an underreported entity in the literature despite their prevalent use and may be related to the symptoms experienced by the patients in this case series.…”

“…2,7,10,11 In pattern C, which is seen in cases of chronic systemic iron overload such as hemochromatosis, iron is deposited in the antral and fundic glandular epithelium. 2,10,11…”

Iron pill induced gastritis in children with iron deficiency anemia

“…In Gastric siderosis, there are inflammatory and regenerative changes [10] . In iron pill induced gastritis there is extracellular deposition of iron in the blood vessels, macrophages, and epithelium [11][12] . Treatment of iron induced gastritis if unidentified will lead to malabsorption leading to malnutrition and failure to thrive (FTT), developmental delay and hemorrhage [13] .…”