Iron overload during the first three months of life appears to be a common problem in infants that receive multiple blood transfusions due to hemolytic disease of the fetus and newborn (HDFN), according to a recently published study in the Indian Journal of Pediatrics.
HDFN is characterized by the destruction of fetal red blood cells due to maternal antibodies, which can lead to severe anemia. An important part of the postnatal management of HDFN-induced anemia consists of blood transfusions that replace the destroyed red blood cells, allowing adequate oxygen transport along the body.
Although their effectiveness is beyond question, there are concerns about the possible complications associated with blood transfusion. Iron overload is one of such complications.
“As there is already an iron overload state, knowing which infants are best suited for iron supplementation becomes imperative,” the authors wrote.
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The authors aimed to assess how prevalent iron overload is in infants with HDFN. The study enrolled 74 infants, of whom over 40% received blood transfusions before birth through the uterus (intrauterine blood transfusions). Researchers measured the levels of a protein called ferritin, which contains iron and helps estimate iron levels in the body.
Results showed that more than 80% had elevated ferritin levels at birth, and approximately 75% continued to have high ferritin levels after three months. About half of the included patients had anemia at birth and required blood transfusions after birth.
The authors pointed out that ferritin is also an acute phase reactant, which means it can also be elevated as a consequence of situations that put the body under stress, such as infection, which was present in four of the infants. Therefore, the authors stated another study that includes a complete iron panel workup should follow this one.
“Most infants born to Rh isoimmunized mothers have iron overload at birth and [three months] of age. A large proportion of these infants also have anemia (but not iron deficiency anemia), requiring multiple PRBC transfusions,” the authors concluded.
