title: Iron is prioritized to red blood cells over the brain in phlebotomized anemic newborn lambs.
abstract: Critically ill preterm and term neonates are at high risk for negative iron balance due to phlebotomy that occurs with frequent laboratory monitoring, and the high iron demand of rapid growth. Understanding the prioritization of iron between red blood cells (RBCs) and brain is important given iron's role in neurodevelopment.
  
  
  
  Ten neonatal twin lamb pairs (n = 20) underwent regular phlebotomy for 11 d. Lambs were randomized to receive no iron or i.v. daily iron supplementation from 1 to 5 mg/kg. Serum hemoglobin concentration and reticulocyte count were assayed, iron balance calculated, and iron content of RBCs, liver, brain, muscle, and heart measured at autopsy.
  
  
  
  Among phlebotomized lambs: (i) liver iron concentration was directly related to net iron balance (r = 0.87; P < 0.001) and (ii) brain iron concentration was reduced as a function of net iron balance (r = 0.63) only after liver iron was depleted. In animals with negative iron balance, total RBC iron was maintained while brain iron concentration decreased as a percentage of the iron present in RBCs (r = -0.70; P < 0.01) and as a function of reticulocyte count (r = -0.63; P < 0.05).
  
  
  
  Phlebotomy-induced negative iron balance limits iron availability to the developing brain.
authors: Children's Hospitals and Clinics of Minnesota, St Paul, Minnesota, USA.|Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA.
authors: Tara G
authors: TG
authors: Zamora
authors: Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA.
authors: Sixto F
authors: SF
authors: Guiang
authors: Department of Pediatrics, University of Iowa School of Medicine, Iowa City, Iowa, USA.
authors: John A
authors: JA
authors: Widness
authors: Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA.
authors: Michael K
authors: MK
authors: Georgieff
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001923:Brain Chemistry; D016638:Critical Illness; D004195:Disease Models, Animal; D004906:Erythrocyte Count; D004912:Erythrocytes / Q000737:chemistry*; D004920:Erythropoiesis; D006400:Hematocrit; D007501:Iron / Q000008:administration & dosage / Q000097:blood*; D008098:Litter Size; D018962:Phlebotomy / Q000379:methods; D011897:Random Allocation; D012756:Sheep; D034561:Sheep, Domestic
chemical_list: D007501:Iron