Haematological changes during parenteral nutrition of malnourished patients with an enteral disease

Abstract

The present study assesses the blood haemoglobin concentration, the mean corpuscular haemoglobin concentration and the mean corpuscular volumes, as well as the serum iron levels and the total iron binding capacities in 28 malnourished patients with an enteral disease before and after 10-12 days of pre-operative parenteral nutrition of three different kinds: one with glucose, a second with glucose and fat as energy source, and a third rich in amino acids. About half of the patients in each group also received intramuscular iron supplementation of 1.79 mmol every 2 days. Before the nutritional therapy, 54% of the patients had a subnormal serum iron level; on average, serum iron was 10.5 (SD 7.4) μmol/l. In spite of this, 50% of the patients had a TIBC level less than normal and 43% of the patients within the normal range. Ninety-three percent of the patients had an anaemia which, in most cases, was normochromic and normocytic. On average, blood haemoglobin was 110 (SD 12) g/l. After 10-12 days of parenteral nutrition, the blood haemoglobin concentration decreased independently of the quality of the intravenous alimentation, the serum iron level and the intramuscular iron supplementation. The fall in the blood haemoglobin level was on average 11.2%. We conclude that either the anaemia of the malnourished patients with enteral disease is not solely dependent on the nutritional supplementation, or it is wholly independent of it; that parenteral nutrition with or without an intramuscular iron supplementation does not improve the blood haemoglobin concentration in anaemic and malnourished patients with an enteral disease in 10-12 days; and that during parenteral nutrition the serum iron level is decreased if the iron supplementation is not given.

Key Words:

• haemoglobin
• parenteral nutrition
• serum iron