Impaired bacteriological responses in babies after maternal iron dextran infusion.

Abstract

SUMMARY The effect of a total dose infusion of iron dextran in pregnancy on 15 mothers and their babies was compared with 19 controls. The bacteriostatic effect and opsonising ability of the sera, of babies born to the treated mothers, were considerably impaired. This was associated with a significantly lower transferrin concentration in these mothers. Although these in vitro tests were not associated with an increase in overt infection during the perinatal period, they suggest the need for caution in the use of total dose infusions in pregnancy.Recent reports by Becroft, Dix, and Farmer' and Barry and Reeve2 have suggested that babies treated with iron dextran (Imferon) by injection, for prevention of anaemia, are more susceptible to infection by Escherichia coli (E coli). It was considered that a similar problem might possibly occur with babies born to mothers who had received a single total dose infusion (TDI) of iron dextran. A study was therefore implemented to examine the effects of maternal TDI on the haemoglobin (Hb), serum iron, and transferrin concentrations of mother and baby and also on in vitro tests of bacteriological competence of the baby. Subjects and methodsA group of 15 mothers who had received a TDI and their babies were compared with 19 control pairs. All were caucasians, managed by the same obstetric teams and tested during a four month period. TDI was given for persistently low maternal'Hb and serum iron concentrations, and failure to respond to oral iron supplements. Controls were selected to match for maternal parity, baby's sex and gestational age. All babies were term by dates and clinical assessment, although one in the treated group was light for dates. Consent for investigation was obtained from the mother, before or as soon as possible after labour began. Blood was taken from her at this time, for Hb, serum iron, and transferrin. Samples of cord blood were taken from all babies for the same tests. In addition 13 babies of the treated group and 17 of the control group had cord blood collected for the Accepted for publication 29 October 1980 bacteriological tests set out below.At three to five days of age capillary blood was collected from all babies for a nitroblue tetrazolium test and stools taken for culture. HAEMATOLOGY AND BIOCHEMISTRYHaemoglobin concentrations were measured using a Coulter S counter. Serum iron concentrations were determined on a Technicon AA11 AutoAnalyzer using a modification of the method of Young and Hicks.3 The normal range for adult females is ,umol/l (28-168 p,g/100 ml), and for cord blood is 14-43 ,tmol/l (78-240 L,g/100 ml).4Transferrin was measured using an automated immuno-precipitin method,5 with polyethylene glycol to accelerate the antigen-antibody reaction. The normal range for adults is 2-0-4-0 g/l and for cord blood is 1-47-2-12 g/1.4 Total iron binding capacity was calculated from the serum transferrin, by multiplying the figure by 1-254 and the percentage saturation of transferrin was calculated from the concentrations of serum iron and t...

Parenteral Iron: Pharmacology and Clinical Use

“…On the other hand, there is ample evidence from both animal and human studies that increased iron levels in the serum following iron-dextran injections lead to impairment of the immune system [59, 60, 61, 62, 63, 64, 65]. Serum ferritin levels after intravenous iron-dextran approach levels seen with classic iron overload [66].…”

“…High levels of iron in the blood following iron-dextran injection facilitate the growth of Escherichia coli in pigs [65], enhance the replication of Mycobacterium avium in human macrophages [62], impair opsonization and phagocytosis of bacteria [59, 64], and also predispose to bacterial sepsis.…”

Evidence that Adequacy of Dialysis Modulates Uremic Anemia

“…Increased serum iron levels following iron infusion enhances replication of bacteria, increases lipid peroxidation, impairs opsonization and phagocytosis of bacteria and increases risk of infection and death [18, 19, 20, 21, 22, 23, 24, 25, 26]. This risk is particularly relevant in patients with ESRD whose immune function is already compromised [27].…”