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Acta Clin Belg. 2013 Jan-Feb;68(1):22-7.

Time course of iron metabolism in critically ill patients.

Author information

1
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.

Abstract

BACKGROUND:

Altered iron metabolism plays a central role in the development of anaemia in critically ill patients but the time course of iron status in septic and non-septic critically ill patients has not been well defined.

METHODS:

Prospective study in a 34-bed medico-surgical ICU. The complete blood count, iron, ferritin, transferrin, and transferrin receptor concentrations, transferrin saturation and C-reactive protein (CRP) concentrations were measured on days 1, 3 and 5 of the ICU stay in 95 consecutive ICU patients (33 with sepsis and 62 without).

RESULTS:

Despite an identical complete blood count on day 1, septic patients had significantly lower iron concentrations (21 [13-34] vs 50[28-75] microg/dL, p<0.001), transferrin concentrations (169[121-215] vs 214[173-247] mg/dL; p=0.003), and transferrin saturation (11[7-15] vs 19[11-25]%; p= 0.004), and higher ferritin concentrations (432[184-773] vs 204[78-354] ng/mL; p=0.002) than non-septic patients. These alterations were associated with a lower reticulocyte count (42[29-61] vs 58[48-77] x 10(3)/mm3; p=0.028). On day 1, CRP concentrations, which were higher in septic than in non-septic patients (20.0[13.5-27.5] vs 2.3[0.7-5.9] mg/dL; p<0.001), were directly correlated with ferritin concentrations (rho=0.55, p<0.001) and inversely correlated with transferrin concentrations (rho=-0.49, p=0.0001) and transferrin saturation (rho=-0.49, p=0.0001). After 3 days, iron and transferrin concentrations were identical in septic and non-septic patients. Iron metabolism remained altered in both populations until the 5th day.

CONCLUSIONS:

Iron status is rapidly altered in critically ill patients, especially in septic patients. These alterations persist during the course of the disease and are associated with decreased erythropoiesis.

PMID:
23627190
DOI:
10.2143/ACB.68.1.2062715
[Indexed for MEDLINE]

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