Plasma iron, transferrin and transferrin saturation of severely malnourished Jamaican children - abstract

ABSTRACT

Mortality amongst severely malnourished children is often associated with an unusually high hepatic store of iron (Fe). Indeed, this excess Fe has been implicated in the aetiology of kwashiorkor. In order to examine the possibility that unbound Fe may be present in the plasma of malnourished Jamaican children, Fe and its transport protein, transferrin were measured. Transferrin saturation ( percentTS) was calculated from plasma Fe and transferrin levels. The measurements were also carried out in a control group of 23 healthy children who had presented for elective minor surgery. Plasma Fe levels (fg/dl) in children with marasmic-kwashiorkor (MK; n = 59. 69ñmeanñ), kwashiorkor (K, n = 37; 76ñ) and in those who died (D;n = 24 111ñ) were not significantly different from the control group (C; 79ñ). In the marasmic group Fe levels (M;n = 63 66ñ g/dl) were significantly lower than (p<0.05) than normal. In malnutrition, transferrin levels (mg/dl) were significantly lower (p<0.001) than normal C - 232ñM - 170ñn = 66 MK - 110ñn = 61 K - 84ñn = 41 D - 77ñn = 24. In the marasmic group transferrin levels were significantly higher (p<0.001) than the other malnourished groups. percentTS was lowest in the marasmic group and highest in the group of children who died. At a percentTS of 30 percent, mortality was 5 per cent compared with a mortality of 24 per cent when percentTS was >90 per cent. It is concluded that oedematous malnourished Jamaican children have normal plasma levels of iron, but significantly reduced levels of circulating transferrin. The latter were more severely decreased in children with kwashiorkor and those who died. Elevated percentTS was associated with increased mortality. It is recommended that iron supplements be witheld during the early stages of resuscitation of the malnourished child (AU)