Iron deficiency anemia and increased urinary norepinephrine excretion

Voorhess, Mary L.; Stuart, Marie J.; Stockman, J.A.; Oski, Frank A.

doi:10.1016/s0022-3476(75)80144-2

Cited by 120 publications

(36 citation statements)

References 15 publications

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“…The lambs received intramuscular antibiotics (1 ml of Combiotic, Henry Schein Inc., Port Washington, NY) immediately preceding catheter flushing. Intramuscular iron dextran complex (equivalent to 100 mg of elemental iron) was given weekly to avoid the hemodynamic effects of iron deficiency (9,10).…”

Section: Methodsmentioning

confidence: 99%

Chronic Anemia in the Newborn Lamb: Cardiovascular Adaptations and Comparison to Chronic Hypoxemia

1988

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ABSTRACT. The cardiovascular adaptations to chronic anemia were studied in the newborn lamb and then compared with the adaptations to chronic hypoxemia. Eight chronically instrumented newborn lambs underwent repeat isovolemic exchange transfusions to maintain their Hb concentrations at 60% of normal for age. Hemodynamic studies were performed twice weekly for 2 wk after which time regional blood flows were measured using radionuclide-labeled microspheres. The major compensatory responses after 2 wk of anemia were moderate increases in heart rate (229 f 20 versus 187 f 15 beatslmin) and cardiac output (226 f 36 versus 165 + 38 ml/kg/min), an increase in fractional extraction of oxygen (65 versus 40%), and a redistribution of regional blood flow. Blood flows to the heart and brain increased whereas blood flows to the viscera and carcass did not change. These compensatory responses were different from those that occur during chronic hypoxemia: specifically, cardiac output did increase, growth was not suppressed, and the pattern of redistribution of regional blood flows was different. The dissimilar effects of anemia (decreasing systemic oxygen content ) versus hypoxemia (decreasing systemic oxygen tension) on local tissue receptors and peripheral chemoreceptors may account for these differences. (Pediatr Res 23: 621-627,1988) During the period of rapid growth after birth, cardiac output and Hb concentration gradually decrease (I). In the presence of a high resting demand for oxygen and a limited ability to further increase cardiac output, this fall in Hb greatly compromises the infant's ability to respond to decreases in systemic oxygen delivery (1-3). When systemic oxygen delivery falls below a critical level, oxygen consumption cannot be maintained and alterations in hemodynamics, metabolism, and growth occur (4, 5).Whereas previous investigators have studied the effects of acute decreases in systemic oxygen delivery in the newborn (5-7), there are currently few data on the effects of prolonged decreases in systemic oxygen delivery. We have previously studied chronic hypoxemia in the newborn lamb using a model of pulmonary stenosis with atrial right to left shunting (4). In this model the decrease in systemic oxygen tension caused a concomitant decrease in systemic oxygen content. The major compensatory Received October 19, 1987; accepted February 9, 1988 responses were a decrease in growth, an increase in Hb concentration, and a redistribution of regional blood flow (4, 8).The purpose herein was to determine the relative contributions of reductions in systemic oxygen tension and systemic oxygen content to the compensatory hemodynamic responses and the growth suppression we had observed during chronic hypoxemia. To do this, we created a model of chronic anemia. Using this model we reduced systemic oxygen content comparably to that achieved in the chronic hypoxemia studies (4, 8), but did not decrease systemic arterial oxygen tension. We then compared the compensatory responses to chronic anemia with those to chro...

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Section: Methodsmentioning

confidence: 99%

Chronic Anemia in the Newborn Lamb: Cardiovascular Adaptations and Comparison to Chronic Hypoxemia

1988

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“…Antibiotics (1 ml of Combiotic, Henry Schein Inc., Port Washington, NY) were given intramuscularly immediately before catheter flushing. Intramuscular iron dextran complex (equivalent to 100 mg of elemental iron) was given weekly to avoid the BERNSTE hemodynamic effects of iron deficiency (6,7). Seven additional lambs underwent thoracotomies at 4 to 25 days of age but did not have atrial septostomies or balloon occluder placement and served as controls.…”

Section: Methodsmentioning

confidence: 99%

Redistribution of Regional Blood Flow and Oxygen Delivery in Experimental Cyanotic Heart Disease in Newborn Lambs

et al. 1987

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ABSTRACT. Redistribution of regional blood flow is an important compensatory response to acute hypoxemia which preserves oxygen delivery to the most vital organs. It is not known if this change in blood flow persists when hypoxemia is prolonged, as occurs in cyanotic congenital heart disease. Chronic hypoxemia was produced in newborn lambs by creating pulmonary stenosis and an atrial septal defect. Oxygen saturation was maintained at 60-70% of control for 2 wk. Distribution of cardiac output was then measured with radionuclide-labeled microspheres. As compared with control, chronic hypoxemia did not alter total cardiac output. Regional blood flow was redistributed, however, the pattern of this redistribution 'was different from that seen during acute hypoxemia. Myocardial and cerebral blood flows, which increase during acute hypoxemia, return to control levels during chronic hypoxemia. Renal, splenic, gastrointestinal, carcass, and skin blood flows remain decreased. Hemoglobin gradually increases so that after 2 wk of hypoxemia total systemic oxygen delivery returns toward control. However, oxygen delivery to all organs except the heart and brain is reduced. Thus, although cardiac output and total systemic oxygen delivery return toward normal during chronic hypoxemia, these measurements may not reflect important regional variations in blood flow and oxygen delivery. Decreased oxygen and substrate delivery to the gastrointestinal tract, liver, and carcass may account for the alterations of metabolism and growth seen in the newborn with cyanotic congenital heart disease. (Pediatr Res 22: 389-393, 1987) When arterial oxygen content is acutely decreased, several compensations occur to maintain adequate tissue oxygen delivery. Two of these compensations are an increase in cardiac output and an increase in oxygen extraction in several vascular beds. However, because the increase in cardiac output may be insufficient to maintain normal systemic oxygen delivery, blood flow is redistributed to the most vital and most metabolically active organs (I, 2). During acute hypoxemia, blood flow increases to the myocardium and brain and decreases to the kidneys, gastrointestinal tract, and skin (3, 4). During chronic hypoxemia, such Received December 11, 1986; accepted May 5, 1987 3Eas occurs in newborns with cyanotic congenital heart disease, additional compensatory mechanisms are invoked. These hemodynamic, hematologic, respiratory, hormonal, and neural adjustments either increase systemic oxygen delivery or reduce oxygen demands.In a previous study of newborn lambs with experimentally produced cyanotic heart disease, we demonstrated that the major compensations to chronic hypoxemia are a decrease in growth and an increase in hemoglobin concentration (5). The decrease in growth may reduce systemic oxygen utilization (3, 5). The increase in hemoglobin increases the blood oxygen-carrying capacity and returns systemic oxygen content to normal. Systemic oxygen delivery can thus be maintained without a chronic increase in cardia...

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“…This decrease in monamine oxidase activity is associated with alterations in catecholamine metabolism in the rat. In a similar fashion iron deficiency produces an increased urinary excretion of norepinephrine in infants and children that promptly returns to normal when iron therapy is instituted (15) (Fig. 5).…”

mentioning

confidence: 85%

1978 Presidential Address of the Society for Pediatric Research

Oski

1978

Pediatr Res

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Iron deficiency anemia and increased urinary norepinephrine excretion

Cited by 120 publications

References 15 publications

Chronic Anemia in the Newborn Lamb: Cardiovascular Adaptations and Comparison to Chronic Hypoxemia

Chronic Anemia in the Newborn Lamb: Cardiovascular Adaptations and Comparison to Chronic Hypoxemia

Redistribution of Regional Blood Flow and Oxygen Delivery in Experimental Cyanotic Heart Disease in Newborn Lambs

1978 Presidential Address of the Society for Pediatric Research

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