Iron supplements and HDFN

Iron is not an acceptable treatment for babies with HDFN. If you were to ask any doctor what the first treatment for mild anemia is, they’ll say iron supplements. While this is true for other types of anemia, this is not the case with hemolytic anemia (the kind you get with hemolytic disease of the fetus and newborn). Iron does not treat hemolytic anemia and if baby were to receive iron and need a transfusion, he would be at risk for iron overload. This can lead to organ damage (especially liver damage), cholestasis, and may require chelation therapy – a risky treatment option. ALWAYS have a ferritin test before giving iron. Below are some articles that talk about why iron should not be given to babies with HDFN.

Iron status in infants with alloimmune haemolytic disease in the first three months of life

 M. E. A. Rath,1 V. E. H. J. Smits-Wintjens,1 D. Oepkes,2 F. J. Walther1 & E. Lopriore1
“On the contrary, iron overload occurs in 70% of neonates with alloimmune HDFN at birth, 50% at the age of 1 month and 18% at the age of 3 months. Therefore, we advise to measure iron status, and we discourage the use of iron supplementation in the first 3 months of life in neonates with alloimmune HDFN. Haemolysis and intrauterine and postnatal transfusions probably both contribute to the high incidence of iron overload in alloimmune HDFN.”
70% of iso babies had iron overload at birth, none were iron deficient at birth, 50% at 1 month had iron overload, and 18% had iron overload at 3 months. “There is a number of case reports published on the risk of severe iron overload, diagnosed by liver biopsies, following IUTs for Rh HDFN. These infants were all born at 33 or 34 weeks of gestation and received 2–5 IUTs and several postnatal transfusions. Their serum ferritin levels ranged from 2479 to 28 800 lg/l. In addition to transfusions for alloimmune HDFN, the haemolysis itself can also contribute to iron overload in alloimmune HDFN.”

Rhesus hemolytic disease of the newborn: postnatal management, associated morbidity and long-term outcome

Vivianne EHJ Smits-Wintjens Frans J Walther Enrico Lopriore
“As discussed above, neonates with RHDN often require IUTs and (multiple) transfusions of red blood cells. The risks and potential consequences of iron overload due to these multiple transfusions are poorly recognized. High levels of cord blood ferritine have been reported in infants with RHDN. As infants with RHDN already have high iron storage, supplementation of iron is not recommended and should not be used.”

A Case of Rhesus Hemolytic Disease With Hemophagocytosis and Severe Iron Overload Due to Multiple Transfusions

Ylmaz, Şebnem MD*ı; Duman, Nuray MD†; Özer, Esra MD†; Kavas, Nazan MD‡; Ören, Hale MD*; Demircioğlu, Fatih MD*; Kumral, Abdullah MD*; Özkan, Hasan MD†; İrken, Gülersu MD*; Özer, Erdener MD
“A 34 weeks’ gestation baby with RHD, who had received multiple intrauterine transfusions (IUT), developed cholestatic hepatic disease and secondary hemophagocytic lymphohistiocytosis (HLH). Her serum ferritin level increased to 5527 ng/mL, and liver biopsy showed severe iron overload. We suggest that patients who have undergone IUT be evaluated for hyperferritinemia.”

Hemolytic Anemia Treatment & Management

Paul Schick, MD
“Iron therapy is contraindicated in most cases of hemolytic anemia. The reason is that iron released from RBCs in most hemolytic anemias is reused and iron stores are not reduced. “


Remember…

  • Babies with HDFN are at high risk for iron overload.
  • Medical literature recommends against iron supplements unless a ferritin test has been run first.
  • Inappropriately administered iron can be dangerous.
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