We often hear not to give IV iron during an active infection... Is there evidence for that statement?
Iron is important for growth of many bacteria, viruses and fungi. Certain organisms are more iron laden than others. In hemochromotosis, certain iron laden infections are more common due to the affinity of the organisms to iron. Various infections caused by organisms including
Vibrio vulniﬁcus, Vibrio cholerae, E. coli, Yersinia enterocolitica and pseudotuberculosis,
L. monocytogenes, P. shigelloides, CMV are others that have been reported in association with hemochromatosis. Fungi including A. fumigatus and Rhizopus species have also been described.
Iron is a central regulator of immune cell proliferation and function. All lymphocyte subsets, including B and T lymphocytes and natural killer (NK) cells, depend on iron uptake, the blockade of which leads to diminished proliferation and differentiation of these cells. Iron loading of macrophages results in the inhibition of IFN-g-mediated pathways and hence they lose their ability to kill intracellular pathogens. Excess iron burden does
not only help the propagation of pathogens, but also plays a sentinel role in modifying the host immune mechanism, speciﬁcally by impairment of cell-mediated immune responses.
Data in CKD patients are conflicting and recent KDIGO work group for anemia in CKD released guidelines for IV iron use. Although clinical judgement drives the decision, the work group suggested not to use IV iron in active systemic infection but no grade was assigned as evidence either way is weak.
Detailed guidelines can be found in Kidney International.
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