# Secondary Iron Overload Due to Amino Acid Chelated Iron Supplementation: A Case Report Involving a Mother and Daughter

## TL;DR

A mother and daughter developed iron overload from long-term use of amino acid chelated iron supplements, highlighting the need for caution and monitoring.

## Contribution

This is the first reported case of secondary iron overload due to amino acid chelated iron supplementation.

## Key findings

- Elevated ferritin levels and increased transferrin saturation were observed in both the mother and daughter.
- MRI confirmed iron accumulation in the liver, spleen, and bone marrow in the daughter.
- Discontinuation of the supplement and phlebotomy led to improvement in hematologic profiles.

## Abstract

Amino acid chelated iron (bisglycinate chelate iron, Ferrochel) has been developed and used as a food fortifier to prevent and treat iron deficiency anemia. However, its long-term use has not been described and reports of iron overload are unavailable. We report a case of a mother and daughter who were diagnosed with iron overload based on blood sampling. Serum analysis revealed elevated ferritin levels and increased transferrin saturation (TSAT). MRI of the daughter showed iron accumulation in the liver, spleen, and bone marrow with normal inflammatory response and no findings suggestive of collagen disease or tumor, and she was diagnosed with secondary iron overload due to oral administration of an amino acid chelated iron preparation. After discontinuing over-the-counter medications and approximately two years of phlebotomy, the women showed a trend toward improvement in their hematologic profiles.

Although amino acid chelated iron supplements can be easily administered without side effects such as nausea, ferritin levels should be checked if they are administered for more than a year. Even asymptomatic patients may suffer from iron overload, which can be very dangerous if left untreated. Therefore, amino acid chelated iron should be considered as medicine rather than as a supplement, and immediate action is needed in these cases. This report highlights the importance of careful medication review of over-the-counter amino acid chelated iron supplements.