Awad Christina, Gilkison Karin, Shaw Erwin
Internal Medicine, US Air Force Hospital Lackland AFB, San Antonio, Texas, USA.
US Air Force Hospital Keesler AFB, Keesler AFB, Mississippi, USA.
BMJ Case Rep. 2019 Mar 15;12(3):e226157. doi: 10.1136/bcr-2018-226157.
Lanthanum carbonate is a phosphate binder that is used to reduce serum phosphate levels in patients with end-stage renal disease (ESRD). Lanthanum forms insoluble lanthanum phosphate complexes that are supposed to pass through the gastrointestinal (GI) tract unabsorbed. Phosphate binders have been reported to deposit in the GI tract and can cause mucosal injury. There are few case reports of GI bleeding associated with phosphate binder deposits. This case report presents a patient with iron deficiency anaemia secondary to biopsy-proven lanthanum deposits in the upper GI tract. There were no overt signs of active GI bleeding. Patient's anaemia improved with discontinuation of the phosphate binder. Lanthanum could be a hidden cause of resistant anaemia among patients with ESRD through asymptomatic GI blood loss.
碳酸镧是一种磷结合剂，用于降低终末期肾病（ESRD）患者的血清磷水平。镧形成不溶性磷酸镧复合物，这些复合物被认为会未经吸收地通过胃肠道（GI）。据报道，磷结合剂会沉积在胃肠道并可能导致粘膜损伤。与磷结合剂沉积相关的胃肠道出血的病例报告很少。本病例报告介绍了一名患者，该患者因经活检证实的上消化道镧沉积继发缺铁性贫血。没有明显的活动性胃肠道出血迹象。停用磷结合剂后患者的贫血症状有所改善。通过无症状的胃肠道失血，镧可能是ESRD患者难治性贫血的一个潜在原因。
