Iron preparation
After transferring to the bone marrow cells, iron forms a complex with heme proteins for hemoglobin synthesis.
Due to the saturation of iron-binding protein ferritin, iron in the plasma becomes toxic, promoting peroxidative mitochondrial damage and thus cell death.
[6][7] The process of iron toxicity is divided into four clinical stages, which are gastrointestinal damage, improvement in condition, metabolic acidosis and hepatic failure, and intestinal obstruction due to scarring.
[10] Iron supplements encourage erythropoiesis to increase red blood cell (RBC) production and oxygen transportation in the circulating system.
Ferritin is then converted into an absorbable form of Fe2+ to bind to transferrin - an iron transporter in the blood circulation.
The raised in transferrin level carried to the bone marrow cells stimulates RBC production, facilitating oxygen transportation in the bloodstream.
Upon stimulation, iron can be transported out as ferroportin and oxidized into transferrin in the sites of action, such as the bone marrow for red blood cell synthesis or in the liver as the storage form of ferritin.
[18] As a strong catalyst, iron is responsible for conversion of reduced forms of O2 into harmful hydroxyl radicals in the body.
Excessive amount of iron leads to production of high dose of reactive oxygen species (ROS).
[21] NTBI is cytotoxic due to its ability to promote the formation of free hydroxyl radicals, one type of ROS [22] Such damage results in swelling and lysis of mitochondria.
The decrease in plasma iron level due to cellular uptake creates a false sense of security.
Hypotension develops again 2 to 5 days after iron ingestion, in association with severe organ dysfunction involving mainly the liver, heart, and brain.
Sudden onset of severe hepatic failure, with hypoglycemia, coagulopathy, and aggravated metabolic acidosis are likely to occur, causing fatal outcome.
Whole-bowel irrigation can be performed with large amounts of an osmotically balanced polyethylene glycol electrolyte solution to flush out excess iron in the GI tract.
Supportive care may also be necessary for patients with breathing difficulty and GI upset, by offering mechanical ventilation and rehydration respectively .
[24] * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Ferrous gluconate is indicated for both prophylaxis and treatment of iron-deficiency anemia.
[26] * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Ferrous fumarate is used in both prophylaxis and treatment of iron-deficiency anemia.
[28] Iron dextran is given by injection and should be used only in the treatment of proven iron-deficiency anemia where oral therapy is ineffective or impracticable.
