Immunity, transferrin, and survival in kwashiorkor

In a study of 40 children with kwashiorkor, serum albumin, transferrin, and immunoglobulin levels were measured. Treatment included chloroquine, pyrimethamine, multivitamins, folic acid, iron compounds, and a high-protein diet. After two weeks the mean serum transferrin values in the children who survived and those who died were 1.30 mg./ml. and 0.33 mg./ml., respectively. Many of the children died immediately after treatment started, and it is suggested that in children with severe kwashiorkor and low serum transferrin levels any increase in free-circulating iron may result in overwhelming infection and death. Thus the appropriate time for instituting iron therapy in such patients should be reconsidered.