Plasma free iron: A possible cause of oedema in kwashiorkor

Abstract

Background - Oedema is a sine qua non for the diagnosis of kwashiorkor yet the mechanisms leading to oedema remain ill defined. Aims - To relate the plasma concentration of radical promoting 'free' iron to the degree of oedema in patients with kwashiorkor. Setting - University teaching hospital. Patients - Fifteen children with kwashiorkor, nine of whom had severe and six of whom had a moderate degree of oedema. Methods - Plasma 'free' iron was measured as bleomycin detectable iron (BDI) and related to severity of oedema and plasma albumin concentration. Results - BDI was significantly higher in the patients with severe oedema (20.5 v 6.75 μmol/l) whereas the albumin concentrations were similar (16 v 17 g/l). BDI was no longer present in any patients 30 days after admission. Conclusions - 'Free' circulating iron may contribute to the oedema of kwashiorkor, and its sequestration could hasten recovery and decrease morbidity and mortality.