Iron status following trauma, excluding burns

Abstract

Serum concentration of iron, transferrin saturation and total iron binding capacity (TIBC) were measured on days 1, 2, 3, 5, 7, 10 and 13 in 36 Thai patients with trauma (burns excluded) to determine temporal changes in iron metabolism. Throughout the study profound hypoferraemia was observed in association with decreased transferrin saturation. TIBC, in contrast, did not differ significantly from that in controls. These findings confirm previous reports which describe altered iron metabolism in association with an adverse event, a response known as 'stress hypoferraemia', and extends these observations to non-burned patients with trauma. The degree of hypoferraemia in patients in this study was not related to sepsis, Injury Severity Score, volume of blood transfused or surgery, suggesting that hypoferraemia following trauma is an independent event. The recognition of rapid and prolonged iron sequestration provides insight into the clinical condition of patients with trauma.

Characterization of Circulating Monocytes Expressing HLA-DR or CD71 and Related Soluble Factors for 2 Weeks after Severe, Non-Thermal Injury1,2

“…Some pulmonary and hematological studies and Spittler's study in hospitalized patients with sepsis, some having undergone surgery, suggest that CD14ϩCD71ϩ monocytes denote early activation or maturation, and might reflect mobilization of young, metabolically active, immunologically maturing cells destined for lymph nodes, spleen, or damaged tissue [46,48,49]. Elevated proportions of CD14ϩCD71ϩ cells may partially account for in vitro immunological deficiencies [31,50,51], and is congruent with our earlier work describing dramatic alterations in several iron metabolism parameters after trauma [17].…”

“…Here, in the second arm of a multiple center trauma study in Bangkok [2,17,18], we measured circulating monocytes expressing HLA-DR and CD71 (transferrin receptor) as well as a panel of monocyte-related circulating factors for 2 weeks, beginning immediately after severe non-thermal injury, with a goal of providing additional longitudinal insight into monocyte response patterns.…”

Ceruloplasmin and Hypoferremia: Studies in Burn and Non-Burn Trauma Patients

“…In the current study, soluble transferrin receptor was significantly lower in burn patients than trauma patients until day 14. The low iron status in critically ill or injured patients has been termed “stress hypoferremia” that appears to be independent of injury severity, blood transfusions, need for surgery or development of sepsis [ 6 ], although others have reported a link between iron status and injury severity [ 7 , 25 ]. Interestingly, efforts to treat this anemia with intravenous iron supplementation have been unsuccessful to the point that such therapy is not recommended [ 12 ], suggesting that factors in addition to simple iron deficiency are involved in the development of this anemia.…”

“…To minimize deleterious effects of iron while providing it to necessary sites within the body, the systemic transport, handling and distribution of iron is normally highly regulated [ 1 , 2 , 3 ]. Although research in this area has provided mechanisms related to most common iron disorders [ 4 , 5 ], much remains to be elucidated about the effects of transient alterations in iron homeostasis that can occur in critically-ill patients [ 6 , 7 ].…”

Iron Overload Before Cecal Ligation and Puncture Increases Mortality

“…Some suggest that elevated plasma iron concentrations are associated with development of complications and mortality, whereas others suggest that elevated plasma iron is not associated with adverse outcome (1,6,(8)(9)(10)(11)(12).…”