iron and infections

[obiwan]

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for some reason i feel this has been passed down in my training to completely avoid iron supplementation in nearly every form of infection just b/c bacteria love iron. i've never really looked into this before but what do you guys think?

 

[Praziquantel86]

I think there's something to it - a key component of the inflammatory response is immediate and large-scale sequestration of iron. Many bacterial virulence mechanisms allow the organism access to iron stores. There has to be an evolutionary reason for that. A meta-analysis published recently in BMJ looking at IV iron supplementation to decrease blood transfusions found a 30% increase in risk of infections (http://www.bmj.com/content/347/bmj.f4822). Chelation therapy with deferoxamine is a classic risk factor for developing mucor, which is able to use the chelated iron as a xenosiderophore.

I'm not aware of anything beyond observational or animal data, but given the physiologic and microbiological mechanisms as well as circumstantial evidence, it doesn't seem like a bad idea to avoid supplementation in patients with known, serious infections. Beyond that, there's the difficulty in determining if a patient with acute inflammation is actually iron deficient, or just seems that way due to the inflammatory response.

 

[Trogghunter]

How about procrit in a patient with hemochromatosis? Riddle me that.