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Iron metabolism in burned children
J A Belmonte1, L Ibáñez, M R Ras
1Paediatric Burns Unit, Hospital Universitari Materno-Infantil Vall d'Hebron, Barcelona, Spain.
Insights
Iron levels in children with burns are low in the acute phase, with decreased sideraemia and transferrin saturation. These iron parameters recover naturally, suggesting iron supplementation is not recommended during the initial stress period for burned patients.
Area of Science:
- Pediatric Burn Care
- Iron Metabolism
- Critical Care Medicine
Background:
- Iron supplementation in pediatric burn patients is controversial.
- Recent evidence suggests against its use during the acute stress phase.
Purpose of the Study:
- To investigate iron metabolism parameter differences between acute and recovery phases in pediatric burn patients.
- To assess the need for iron supplementation in the acute phase of burns.
Main Methods:
- Studied 21 pediatric burn patients (burns >10% body surface) without transfusions or iron supplementation.
- Assessed sideraemia, ferritin, transferrin, transferrin saturation index (TSI), and C-reactive protein (CRP) in acute and recovery phases.
Main Results:
- Sideraemia, transferrin, and TSI were significantly lower in the acute phase compared to the recovery phase.
- Plasma ferritin and CRP levels were significantly higher in the acute phase.
- Observed differences persisted across different age groups.
Conclusions:
- Hyposideraemia and decreased transferrin are common in acute pediatric burns.
- Iron levels tend to recover naturally, indicating an endogenous block of iron release.
- Iron therapy is not recommended during the initial acute stress period for burned children.
Unlabelled:
The administration of iron supplementation in children with burns has been a subject of controversy. Recent studies argue against its use in the acute phase of stress. To assess whether iron metabolism parameters show significant differences in the acute phase and the recovery phase of burn, 21 patients (age range: 17 months to 13 years) with burns of more than 10% of body surface who had not received blood transfusions or iron supplementation were studied. Sideraemia, ferritin, transferrin, transferrin saturation index (TSI) and C-reactive protein (CRP) were assessed both in the acute and the recovery phase after burn. Sideraemia, transferrin, and TSI were significantly lower in the acute than in the recovery phase (17.3 +/- 3 vs 53.8 +/- 6.6 microg/dL, 190.5 +/- 15 vs 287.9 +/- 14.3 mg/dL and 7.7 +/- 1.3 vs 15.4 +/- 1.6%, P < 0.0001, P < 0.001 and P = 0.0006, respectively) while plasma ferritin and CRP were significantly higher (84.7 +/- 8.8 vs 43.1 +/- 8.5 ng/mL and 9.5 +/- 1.5 vs 0.7 +/- 0.2 mg/dL, P = 0.016 and P < 0.0001, respectively). When the above parameters were analysed based on age (< or = 2 years, > 2 years), the observed differences persisted.
Conclusion:
Hyposideraemia is a frequent finding in the acute phase of paediatric burns and is accompanied by increased ferritin levels and decreased transferrin concentrations. The low iron values tend to recover without the use of iron supplementation suggesting an endogenous block of iron release in the acute phase and indicates that iron therapy should be not recommended in the initial period of stress of the burned patient.