The pronounced and persistent hypoferremia which accompanies infection, and the rapidity with which intravenously injected iron is removed when given in such cases (1), have led to the suggestion that the anemia of chronic infection results from a local iron deficiency in the bone marrow. Since the quantity of free protoporphyrin in the erythrocytes has been found increased in association with the anemia of infection, the possibility exists that this anemia is the consequence of deficient formation of hemoglobin resulting from a lack of iron. The studies to be described here were designed to test the validity of this hypothesis. Iron was infused continuously in patients with chronic infection in order to determine whether, by raising the iron level to the normal value, synthesis of hemoglobin could be induced. These observations have made it possible to study the rate and degree of diversion of iron from the plasma in infection. Several observations also have been made of the uptake of intravenously administered radioactive iron by the red cells of patients with acute and chronic infections. Evidence will be presented in this communication suggesting that while a rapid removal from the plasma of injected iron occurs in infection, another factor, rather than lack of iron, may be responsible for the development of anemia.
METHODSFerrous ascorbate was used for the continuous infusion studies. A 2 per cent aqueous solution was carried through a Seitz filter. With a syringe this was added to a bottle containing 500 ml. sterile 5 per cent glucose solution; thus, the final solution contained 4 mgm. of iron per 100 ml. Since-ferrous ascorbate is a complex with varying amounts of iron (2), each lot had to be analyzed, and the amount used varied accordingly. To obtain quickly the elevated plasma iron level, a single dose of