Iron Supplementation and Splenic Health

Understanding Iron Deposition in the Spleen

Severe iron overload from repeated blood transfusions and/or prolonged intravenous iron administration leads to hepatosplenic siderosis, where iron deposits accumulate in the liver, spleen, and other organs 1, 2, 3
Post-mortem studies from dialysis patients in the pre-erythropoietin era showed that massive hepatosplenic siderosis only occurred in patients who had been on dialysis for more than 3 years with extensive IV iron use 1, 2, 3
The main iron storage site in the spleen is in cells lining the splenic sinusoids, with the white pulp usually spared 2, 3
Importantly, even massive hepatic and splenic siderosis was not associated with pain or organ dysfunction in these autopsy studies 1, 2

Oral iron supplementation at recommended doses (100-200 mg elemental iron daily) does not cause iron overload or splenic complications, according to the American Gastroenterological Association and other guideline societies 4, 5, 6, 7
Common side effects of oral iron are gastrointestinal, including constipation, diarrhea, and nausea, which are the most frequent adverse effects 5, 6, 7

If a patient on iron supplementation reports left upper quadrant or splenic area pain, consider pre-existing splenic pathology, such as splenomegaly from other causes, as recommended by the American College of Gastroenterology 2
Left upper quadrant pain can originate from the stomach, pancreas, kidney, or musculoskeletal structures, and should be investigated as such 4

Iron supplementation should be continued as prescribed for iron deficiency anemia, as the spleen is not a target organ for toxicity from therapeutic iron supplementation, according to the National Institute of Diabetes and Digestive and Kidney Diseases 4, 5, 8