ACTIVATED HEPATIC STELLATE CELLS PARTICIPATE IN LIVER FIBROSIS IN A PATIENT WITH TRANSFUSIONAL IRON OVERLOAD

We describe liver fibrosis caused by iron overload after a long histor y of blood transfusion in a patient with chronic renal failure. Pertin ent laboratory data were: serum (s)-Fe 148 mu g/dl; unsaturated iron b inding capacity (UIBC) 14 mu g/dl; s-ferritin 9350 ng/ml; human leukoc yte antigen (HLA) A2, A24, B39, B55, Cw1, Cw7. Computed tomography rev ealed a high density in the liver, and laparoscopy revealed a brown li ver. Liver histology showed bridging fibrosis from portal tracts. A he avy iron deposit was seen in Kupffer cells as well as in hepatocytes s urrounded by fibrosis around the portal tracts. Immunocytochemistry re vealed ct-smooth muscle actin in many stellate cells distributed along the fibrotic area, and electron microscopy revealed infiltrating myof ibroblastic stellate cells coexisting with collagen fibers around dege nerated hepatocytes containing iron deposits. The findings are consist ent with the notion that stellate cells play an important role in live r fibrogenesis in both genetic and transfusional iron overload hemochr omatosis.