Validity of self-reported receipt of iron supplements during pregnancy: implications for coverage measurement

Febrile malaria and asymptomatic malaria parasitemia substantially decrease iron absorption in single-meal, stable isotope studies in women and children, but to date there is no evidence of decreased efficacy of iron-fortified foods in malaria-endemic regions. Without inadequate malarial surveillance or health care, giving iron supplements to children in areas of high transmission could increase morbidity and mortality. The most likely explanation is the appearance of non-transferrin-bound iron (NTBI) in the plasma. NTBI forms when the rate of iron influx into the plasma exceeds the rate of iron binding to transferrin. Two studies in women have reported substantially increased NTBI with the ingestion of iron supplements. Our studies confirm this, but found no significant increase in NTBI on consumption of iron-fortified food. It seems likely that the malarial parasite in hepatocytes can utilize NTBI, but it cannot do so in infected erythrocytes. NTBI however may increase the sequestration of parasite-infected erythrocytes in capillaries. Bacteremia is common in children with severe malaria and sequestration in villi capillaries could lead to a breaching of the intestinal barrier, allowing the passage of pathogenic bacteria into the systemic circulation. This is especially important as frequent high iron doses increase the number of pathogens in the intestine at the expense of the barrier bacteria.

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Suicide by intoxication with iron (III) chloride

Forensic Toxicology ◽

10.1007/s11419-021-00579-6 ◽

2021 ◽

Author(s):

Sławomir Majdanik ◽

Barbara Potocka-Banaś ◽

Sebastian Glowinski ◽

Krzysztof Borowiak

Keyword(s):

Prussian Blue ◽

Chloride Ions ◽

Iron Chloride ◽

Histopathological Analysis ◽

Fatal Intoxication ◽

Internal Organs ◽

Specific Staining ◽

Iron Supplements ◽

Staining Protocol ◽

Hematoxylin And Eosin

Abstract Purpose Cases of iron intoxication are not very often encountered in toxicology practice, and most of those reported concern accidental intoxications with iron supplements in young children. The paper presents a rare case of a suicide by intoxication in an adult woman who ingested a solution of iron (III) chloride. Methods A forensic was at the Department of Forensic Medicine, PMU in Szczecin. Toxicology tests of blood sampled from the deceased were performed using a 644 CIBA CORNING ion selective analyzer and proprietary reagent kits. Histopathological was with the use of the standard staining protocol (hematoxylin and eosin) and staining specific for iron (Prussian blue). Results Autopsy revealed a distinct yellow discolouration and thrombotic necrosis of the oral mucosa and almost the whole gastrointestinal tract, as well as similar changes in the adjacent internal organs. Considerably high levels of iron and chloride ions were detected in specimens of internal organs preserved during autopsy. Histopathological analysis performed with the use of staining specific for iron (Prussian blue) also confirmed the presence of iron in the examined tissues, especially in the intestines and liver. Conclusions Considering the above findings, it was concluded in the forensic report that the death of the woman was caused by the ingestion of iron chloride. The reported case of fatal intoxication is one of the few described in the literature, and its course implies that in the case of initially diagnosed intoxication with corrosive compounds, the possibility of using metal-containing poison should also be considered in the differential diagnosis. In addition to routine toxicological tests performed in fatal cases we also draw attention to the possibility of using specific staining protocols for microscopic specimens.

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