Iron deposition in autopsied liver on patients receiving long-term TPN
Akatsu, Hiroyasu Nagoya City University|Fukushimura Hospital|National Center for Geriatrics and Gerontology
Manabe, Toshie Jichi Medical University
Kawade, Yoshihiro Nagoya City University
Tanaka, Hajime Nagoya City University
Kanematsu, Takayoshi Nagoya City University
Arakawa, Kazuyuki Nagoya City University
Masaki, Yoshiyuki Nagoya City University
Hishida, Chie Fukushimura Hospital
Kanesaka, Takeshi Fukushimura Hospital
Ogawa, Norihiro Fukushimura Hospital
Hashizume, Yoshio Fukushimura Hospital
Tsuneyama, Koichi Tokushima University Tokushima University Educator and Researcher Directory KAKEN Search Researchers
Ohara, Hirotaka Nagoya City University
Maruyama, Mitsuo National Center for Geriatrics and Gerontology
Yamamoto, Takayuki Fukushimura Hospital
Vitamins and minerals are routinely administered by total parenteral nutrition (TPN). However, in Japan, adjustments in iron dosage are difficult because blended mineral preparations are often used. It is therefore unclear whether the iron content is appropriate in cases of long-term TPN. The aim of the study was to assess the influence of iron administration by long-term TPN on iron deposition in post-mortem liver samples isolated from older deceased patients.
Liver tissues were collected from post-mortem autopsies of 187 patients over a period of 15 years. Samples were stained with Prussian blue and histologically evaluated from Grade 0–V by at least three different observers. Specimens with positive and negative iron staining were compared, and positive samples were grouped according to the level and distribution of the staining. Post-mortem blood obtained from the subclavian vein during autopsy was also analysed. Samples were collected for the measurement of unsaturated serum iron, serum iron, albumin, prealbumin, hepcidin, and IL-6 concentrations.
Iron accumulation in the liver was significantly higher in male patients (p = 0.005) with a history of surgery (p = 0.044) or central vein administration of iron (p<0.001). Additionally, the duration of TPN in the iron-positive group was significantly longer than in the iron-negative group (p = 0.038). Serum analysis revealed that unsaturated serum iron was significantly higher in the iron-negative group and that ferritin and serum iron were significantly higher in the iron-positive group. No other statistically significant differences were observed between the two groups.
Chronic intravenous administration of iron was associated with iron deposition in the liver, even when given the minimum recommended dosage. In long-term TPN patients, the iron dose should therefore be carefully considered.
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