Bone marrow and chelatable iron in patients with protein energy malnutrition.

OBJECTIVES

To examine the iron status of malnourished children by comparing bone marrow iron deposits in children with protein energy malnutrition with those in well-nourished controls, and measuring chelatable urinary iron excretion in children with kwashiorkor.

DESIGN

Bone marrow iron was assessed histologically in postmortem specimens from children with kwashiorkor or marasmus, and from controls. Twenty-four-hour urinary iron was measured in children with severe kwashiorkor, half of whom received 10 mg/kg of intramuscular desferrioxamine (DFO) on admission.

SETTING

Red Cross War Memorial Children's Hospital, Cape Town.

SUBJECTS

Thirteen children with kwashiorkor, 6 with marasmus and 16 well-nourished children underwent bone marrow examination. Urinary iron excretion was assayed in 17 children with kwashiorkor.

RESULTS

Stainable iron was present in the bone marrow of half the children with kwashiorkor but in only 1 child in each of the other groups. The median iron excretion was 945.5 micrograms/24 hours in the DFO group compared with 28.5 micrograms/24 hours in the non-DFO group.

CONCLUSIONS

There is an apparent excess of iron which may predispose to bacterial infections and free radical-mediated injury in children with kwashiorkor.