Is bleomycin-detectable iron present in the plasma of patients with septic shock?

To assess plasma iron status in critically ill patients with septic shock.

Observational, prospective study.

Adult intensive care units in teaching and tertiary referral hospitals.

Fifteen adult patients with established septic shock. Normal control subjects (n = 10) were also investigated. Data from patients and controls were compared with previously published iron values in critical care patients.

The indices investigated and correlated with clinical scores of illness severity included bleomycin-detectable iron, non-haem iron; transferrin and its percentage iron saturation, and the iron binding (anti-oxidant) activity of transferrin. Bleomycin-detectable iron was not present in the plasma of patients with septic shock whilst the plasma transferrin remained unsaturated with iron. One patient in multi-organ failure displayed bleomycin-detectable iron in plasma (1.16 mumol/l) and had 100% iron-saturation of transferrin. The plasma non-haem iron levels (7.84 +/- 1.82 mumol/l) were the lowest of all critical care patient groups studied by us. The plasma transferrin levels were also low but resulted in a near normal percentage saturation of transferrin with iron (34.6 +/- 6.5%). The scores of clinical severity correlated with changes in plasma iron chemistry.

Patients with septic shock rarely have iron saturated transferrin in their plasma leading to the presence of bleomycin-detectable iron.