Background No studies have been performed comparing intravenous iron with transfused red cells (RBC) for treating anemia during infection. In a previous report, transfused older RBC increased free iron release and mortality in infected animals when compared to fresher cells. We hypothesized that treating anemia during infection with transfused fresh RBC, with minimal free iron release, would prove superior to intravenous iron therapy. Methods Purpose-bred-beagles (n=42) with experimental S. aureus pneumonia rendered anemic were randomized to be transfused RBCs stored for 7-days or one of two intravenous iron preparations (7mg/kg), iron sucrose, a widely-used preparation, or ferumoxytol, a newer formulation that blunts circulating iron levels. Results Both irons increased the alveolar-arterial-oxygen gradient at 24–48-hours (p=0.02–0.001), worsened shock at 16-hours (p=0.02– p=0.003 respectively), and reduced survival (transfusion 56%; iron sucrose 8%, p=0.01; ferumoxytol 9%, p=0.04). Compared to fresh RBC transfusion, plasma iron measured by non-transferrin-bound iron (NTBI) levels increased with iron sucrose at 7, 10, 13, 16, 24 and 48-hours, (p=0.04 to p<0.0001) and ferumoxytol at 7, 24 and 48-hours (p=0.04 to p=0.004). No significant differences in cardiac filling pressures or performance, hemoglobin or cell free hemoglobin were observed. Conclusions During canine experimental bacterial pneumonia, treatment of mild anemia with intravenous iron significantly increased free iron levels, shock, lung injury, and mortality compared to transfusion of fresh RBC. This was true for iron preparations that do or do not blunt circulating free iron level elevations. These findings suggest that treatment of anemia with intravenous iron during infection should be undertaken with caution.

Bu ered solutions versus 0.9% saline for resuscitation in critically ill adults and children.

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