Elevated serum iron, low unbound transferrin and candidiasis in acute leukemia.

By LEONA CAROLINE, FRED ROSNER AND PHILIP J. KOZINN T RANSFERRIN OR SIDEROPHILIN is the iron binding protein of human plasma and has the electrophoretic mobility of a beta-l-globulin. Normally only about one third of the transferrin is saturated with iron.1 In 1946, Schade and Caroline2 demonstrated the bacteriostatic effect of transferrin. This in vitro antimicrobial power is depressed by free iron and enhanced by an increase in iron-binding capacity.3 Fresh human serum has also been shown to be fungistatic.4#{176} This inhibition of fungal growth can be overcome by the addition of iron.7’8 Thus, the fungistatic principle in normal human serum may be transferrin. Serum from patients with acute leukemia has been shown to have a markedlv reduced capacity to inhibit the growth of yeasts such as Candida.#{176}’1#{176} The present report demonstrates that many patients with acute myeloblastic leukemia have elevated serum iron levels and nearly totally saturated serum iron-binding capacities. Some of these patients had systemic candidiasis, elevated Candida agglutination titers and positive anticandidal precipitin tests. It is postulated that these aberrations in iron metabolism in patients with acute leukemia may be causally related to the development of candida and other fungal infections.1’ In vivo and in vitro studies support this hypothesis.