Impact of Iron Metabolic Disturbances on Hemostasis in Critical Conditions

Abstract

Objective: To determine the regularities of iron metabolic disturbances and their impact on the hemostatic system in critically ill patients due to the severe course of generalized purulent peritonitis, acute pancreatitis, and thermal skin injuries. Materials and methods. In 36 patients with an APACHE II of 22.6±3.4 scores, endogenous iron metabolism was assessed by the level of serum iron, total serum syderopexy power, transferrin iron accumulation, ferritin concentrations, and free hemoglobin levels in blood; the antioxidative protective system, lipid peroxidation activity, and hemostatic parameters are studied. Results. There are general regularities in the hemostatic influence of the high concentrations of free hemoglobin and free radical oxidation products in critically ill patients due to generalized peritonitis, acute pancreatitis, or thermal skin injuries. In these patients, iron metabolism occurs with the overload of transporter proteins, such as transferrin and ferritin. Conclusion. Microcirculatory disorders as intravascular hemolysis and hemoglobin metabolism to ionized iron activate lipid peroxidation in the presence of excess Fe2+, which favors strain of the hemostatic system, by determining a tendency toward hypo- or hypercoagulation via the lowered activity of the platelets dependent on the state of free radical processes. Key words: ionized iron, transferrin, ferritin, lipid peroxidation, intravascular hemolysis, hemostasis.