SUMMARY The effect of intravenous iron dextran on serum ferritin levels was observed in two patients with iron deficiency anaemia. Serum ferritin levels rose sharply and reached peak levels seven to nine days after infusion when at least 90 %of the infused iron had been removed from the plasma.A linear relation was shown for each patient between the logarithm of the serum ferritin levels and the logarithm of the calculated cellular non-haem iron levels. Material and methods CASE 2A 76-year-old man with anaemia (Hb 8·9 gjd!) had severe atrophic gastritis demonstrated by gastroscopy. MCV, serum iron, transferrin, and ferritin levels were consistent with iron deficiency. There was no history of chronic blood loss, and faecal blood loss studies were normal. He had been transfused to a Hb level of 11·0 gldl three days before iron therapy was given. Since oral iron would be poorly absorbed because of gastritis, 20 mI of iron dextran (Imferon ®, Fisons) was infused intravenously with 500 ml of normal saline, a total dose of 1 g of elemental iron. Serum ferritin was estimated by a two-site immunoradiometric assay, 3 and serum iron as recommended by the International Committee for Standardisation in Haernatolcgy," incubating for 2 hours with chromagen solution to ensure complete measurement of Imferon ® iron. Haematological measurements were made on a Model S Coulter Counter. Red cell mass, total blood volume, and plasma volume were determined using patient's red cells labelled with oICr.°T otal plasma iron was calculated from the serum iron level and the plasma volume. Iron utilised for Hb synthesis was calculated from the formula: changeinHb Iron (mg) = 100 x Blood volume (mI) x 3·4 Cellular non-haem iron (CNHI) was calculated to be the amount of iron removed from the plasma less that required for the observed Hb synthesis. Iron stores before infusion were assumed to be zero for the purpose of these calculations. The levels of CNHI in case I were calculated for only the first II 215 Patients CASE 1

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