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To determine if hypoxemia from anemia in infancy causes brain damage, 61 full term infants from comparable socioeconomic groups were studied developmentally from birth to 7 years Thirty-two of the infants developed iron deficiency anemia between 6-18 months of age (Hgb range 6.1-9.5 G%) in the absence of protein calorie malnutrition. Twenty-nine infants received neonatal iron dextran injections and were not anemic (Hgb range 11.5-12.96%). Neurological evaluation was done at 6-7 years of age without knowledge of the presence or absence of prior anemia. Each test was rated on a 0-3 scale or by stanines. The group formerly anemic had a higher incidence of “soft signs” e.g. clumsiness with balancing on one foot, in tandem walking, and repetitive hand or foot movements, etc. and were more inattentive and hyperactive than the non anemic group. Binet IQ scores averaged 98 in the non anemic and 92 in the anemic group. Anemia in infancy appears to be one cause of minimal brain dysfunction which may be permanent.

Summary: Mackler et al. (1) found markedly elevated plasma concentrations of phenylalanine in rats made iron deficient; phenylalanine levels returned to control levels within one week after rats were treated with iron dextran. Plasma phenylalanine levels, the authors stated, "appeared to vary directly with the degree of iron deficiency."

Excerpt To the Editor:The incidence of adverse systemic reactions to iron dextran is 3%; that of life-threatening reactions is 0.6% (1). We present a method for desensitization before iron dextran ...

In Reply.— All of our patients with dialysis siderosis received intravenous iron dextran. We agree with Bregman and colleagues that iron dextran appears to be the principal cause of the dissociation between the hepatic and the bone marrow iron in these patients. However, this may not be the sole cause of this phenomenon. Recently, we observed this paradox of hepatosplenic siderosis and marrowiron depletion in nondialysis patients with liver cirrhosis. Other published observations of Bregman et al 1 concerning HLA-linked iron overload, myopathy, marrow iron, and serum ferritin are in basic alignment with ours. They furnish no data concerning hepatic iron stores. Their argument seems to center about the validity of the serum ferritin as a marker of bone marrow iron. Since our aforementioned study, we have reported the association of high serum ferritin levels and depletion of marrow iron stores in ten of 36 dialysis patients with hepatosplenic siderosis.

Excerpt To the Editor:The following comments seem appropriate to "Fatal Anaphylaxis After Intramuscular Iron-Dextran," which appeared in the ANNALS65: 745, 1966. Kabat, Turino, Tarrow, and Maurer (...

Previous investigators in Great Britain and this country have examined the clinical effect of intramuscular iron-dextran in subjects with iron-deficiency anemia.1-7In these reports, morphologic changes in the peripheral blood stream and marrow organ that followed use of iron-dextran received sparse attention. These responses judge the physiologic utilization of iron derived from its dextran-complexed source in hematopoiesis. Likewise, lack of these characteristic changes should alert the clinician to question the accuracy of his diagnosis of iron deficiency and to inquire if another mechanism is responsible for anemia. This study was conducted in 20 children with iron-deficiency anemia of infancy. Its primary purpose was to assess hematopoietic responses to iron-dextran therapy in this age group. Materials and Methods Patients Studied.—All infants had admissions to the Department of Pediatrics, Harrisburg Hospital, for duration of this investigation, which was usually 21 days. The age of children so observed spanned 7 to

A. Introduction During the past several years there has been a recrudescence of interest in the metabolism of iron together with a new interest in the treatment of iron-deficiency anemia. This has been brought about because of the availability of new investigative tools and techniques and by the manufacture of new and effective parenteral iron products. It is the purpose of this paper to report on a clinical trial of an iron-dextran complex for intramuscular administration (Imferon), used in the treatment of iron-deficiency anemia in infants and children. B. Materials and Methods Sixty-five infants and children are included in this study. The ages range from 2 months to 7 years, with a mean age of 14 months. There are 37 boys and 28 girls. Of these, 51 are Caucasians, 6 are Spanish-Americans, 7 are Negroes, and 1 is Oriental. Twenty-five of these patients had birth weights under 2500 gm. In

Excerpt Iron-dextran has been commercially available in the United States since 1957. Despite widespread use, untoward side effects have been uncommon, most often involving local discomfort or stai...