The Effects of Deferoxamine Mesylate on Iron Elimination after Blood Transfusion in Neonatal Foals

Background: Hepatic failure is one of the more common complications in foals requiring blood transfusion to treat neonatal isoerythrolysis. Iron intoxication is likely the cause of hepatic injury. Objectives: To determine the effects of deferoxamine on iron elimination in normal foals. Animals: Thirteen neonatal foals. Methods: Randomized-controlled trial. At 1-3 days of age, foals received either 3L of washed packed dam's red blood cells (RBC) or 3 L of saline IV once. Foals were treated with deferoxamine (1 g) or saline (5 mL) SC twice daily for 14 days. Foals were randomly assigned to 1 of 3 groups: RBC/deferoxamine (deferoxamine), RBC/saline (placebo), or saline/saline (control). Blood and urine samples and liver biopsy specimens were collected for measurement of hematological, biochemical, and iron metabolism variables. Results: There was a significant (P < .05) increase in hematocrit, RBC count, and hemoglobin in the groups transfused with packed RBC as compared with controls at all times. Biochemical variables and liver biopsy scores were not significantly different between groups at any time. Urine iron concentrations and fractional excretion of iron were significantly higher in deferoxamine treated foals. By 14 days after transfusion, liver iron concentrations in foals treated with deferoxamine (79.9 +/- 30.9 ppm) were significantly lower than that of foals receiving placebo (145 +/- 53.0 ppm) and similar to that of controls (44.8 +/- 4.09 ppm). Conclusions and Clinical Importance: Deferoxamine enhances urinary iron elimination and decreases hepatic iron accumulation after blood transfusion in foals.