Increased Hemolysis after Intramuscular Iron Administration in Patients with Paroxysmal Nocturnal Hemoglobinuria : Report of Six Occurrences in Four Patients, and Speculations on a Possible Mechanism

Four patients with PNH were described who developed accelerated activity of their disease after the intramuscular administration of iron-dextran for treatment of iron deficiency. This was considered to reflect a unique effect of iron on PNH erythrocytes. It was postulated that this effect resulted from cell damage caused by iron catalyzed peroxidation of erythrocyte lipids, a reaction to which PNH erythrocytes could be unusually susceptible by virtue of an increased content of unsaturated fatty acids or pro-oxidants or decreased content of antioxidants.