title: Mechanisms of aluminum-induced microcytosis: lessons from accidental aluminum intoxication.
abstract: Twenty-three hemodialysis patients exposed to an accidental aluminum overload, showed increased erythropoietin requirements and decreased erythrocyte mean corpuscular volume (MCV). At the peak of the intoxication, MCV and plasma aluminum levels changed from unrelated (r = 0.02) to strongly related (r = 0.425) variables. The molar proportion of plasma aluminum to plasma iron increased dramatically (from 1:13.8 to 1:2.4). This significant increment in the aluminum/iron ratio made higher the relative offer of aluminum with respect to iron to the erythroid precursor cells. Accordingly, in a subset of 13 randomly selected aluminum-intoxicated patients we found increased intraerythrocytic aluminum, which paralleled the increase in plasma aluminum. Furthermore, in the aluminum-intoxicated group, intraerythrocytic ferritin, a marker of iron content, and the ratio between erythrocyte and plasma ferritin were lower (P < 0.01 and < 0.001, respectively), than in the control group. These findings support the hypothesis that in some cases of aluminum-related microcytosis, a ferropenic mycrocitosis, as expression of erythroid ferropenia, may exist in spite of the presence of normal body iron stores.
authors.affiliation: Fundación Jiménez-Díaz, Madrid-Oviedo, Spain.
authors.forename: C A
authors.initials: CA
authors.lastname: Caramelo
authors.forename: J B
authors.initials: JB
authors.lastname: Cannata
authors.forename: M R
authors.initials: MR
authors.lastname: Rodeles
authors.forename: J L
authors.initials: JL
authors.lastname: Fernández Martín
authors.forename: J R
authors.initials: JR
authors.lastname: Mosquera
authors.forename: B
authors.initials: B
authors.lastname: Monzú
authors.forename: J
authors.initials: J
authors.lastname: Outeiriño
authors.forename: G
authors.initials: G
authors.lastname: Blum
authors.forename: C
authors.initials: C
authors.lastname: Andrea
authors.forename: A J
authors.initials: AJ
authors.lastname: Lopez Farré
mesh_terms: D000535:Aluminum / Q000097:blood; D017607:Aluminum Compounds / Q000506:poisoning*; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000139:chemically induced*; D004906:Erythrocyte Count; D004909:Erythrocyte Indices; D004913:Erythrocytes, Abnormal / Q000378:metabolism; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D007501:Iron / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects
chemical_list: D017607:Aluminum Compounds; D005293:Ferritins; D000535:Aluminum; D007501:Iron