Chiefs’ Inquiry Corner – 1/27/20

January 27, 2020

Being an outstanding physician and lifelong learner requires stoking the flames of clinical curiosity.  In Chiefs’ Inquiry Corner (CIC) we attempt to succinctly answer actual clinical questions that have been raised on the wards and in the clinics of NYU’s teaching hospitals.  Our answers are not meant to be all encompassing or practice changing but rather to serve as springboards for further exploration. For those of us with short attention spans, we hope CIC satisfies that craving for a morsel of knowledge in a digestible format.


Click to toggle the answers!

The iron-infection hypothesis postulates that because bacteria need iron to survive and replicate, our bodies have evolved to respond to infections by sequestering iron intracellularly away from the extracellular bacteria. Although the most recent, large meta-analysis suggests routine use of IV iron was not associated with an increased risk of infections, is there any data on the safety of giving IV iron to patients who are actively infected? Sadly, there is no good data for humans (only animal studies). So, as always, weigh the risks and benefits each time. 

References:Infection and IV Iron  
It is an established phenomenon that patients with well-controlled HIV can see a tremendous drop in their CD4 count during acute illness. This effect can also be seen in critically ill patients even without HIV. This drop is transient and should not be used to guide primary prophylaxis; rather CD4 evaluation should wait until resolution of the acute illness. 

References:Interpreting CD4 Counts in HIV  
Hydroxyurea increases levels of HbF, thereby reducing risk of vaso-occlusive crises in patients with sickle cell disease. Among other mechanisms, hydroxyurea inhibits ribonucleotide reductase, preventing DNA repair and causing transient myelosuppression. The short half life likely contributes to rebound HbF production, however the exact mechanism is poorly understood. 

References: Hydroxyurea in Sickle Cell Disease