Iron deficiency in sepsis patients managed with divided doses of iron dextran: a prospective cohort study

Iron deficiency (ID) impairs hemoglobin (Hb) synthesis and immune function, both crucial for sepsis patients. We assessed the impact of iron dextran on reticulocyte (Ret) Hb equivalent (Ret-He) and Ret subpopulations in iron-deficient sepsis patients. In this prospective clinical study we enrolled patients with sepsis or septic shock with procalcitonin concentration > 0.5 ng/mL, diagnosed with ID based on Ret-He. Study subjects received divided doses of iron dextran until normalization of Ret-He. The study population included 35 subjects. The median Ret-He increase after 2 doses of iron dextran was 3.0 (IQR 1.9–6.1) pg (p < 0.01) with median time to normalization 4 (IQR 3–5) days. Although no change in Ret percentage [Me 1.5 (IQR 1.1–2.1) vs. Me 1.4 (IQR 1.1–2.4) %, p = 0.39] and number [Me 0.05 (IQR 0.04–0.07) vs. Me 0.05 (IQR 0.03–0.06) 10(6)/µL, p = 0.88] was noted, Ret subpopulations changed significantly (p for all < 0.01). Divided doses of iron dextran relatively quickly normalize Ret-He in iron-deficient sepsis patients. Changes in Ret subpopulations suggest increased erythropoietic activity. Further research is needed to explore the role of intravenous iron in this clinical setting.