Elevated Serum Iron, Low Unbound Transferrin and Candidiasis in Acute Leukemia

Patients with acute leukemia have been shown to have elevated serum iron levels and markedly diminished or absent unbound iron binding capacity (21 of 34 patients with myeloblastic and 2 of 6 patients with lymphoblastic leukemia). Four patients (2 myeloblastic and 2 lymphoblastic) developed systemic candidiasis with elevated Candida agglutination titers and positive precipitin tests against a somatic antigen of Candida albicans. It is postulated that high serum iron and/or low unbound transferrin predispose patients with acute leukemia to candidal infection by enhancing growth of this fungus. In vitro studies support this hypothesis.