To the Editor.—
I would take issue with some of the evidence and the conclusions reached in the recent article on the interaction of sickle cell anemia (SCA) and iron deficiency by Natta et al (1982;247:1442) and the accompanying editorial by Nalbandian (1982;247:1462). While the patient described by Natta and co-workers has clearly become iron deficient, the data reported by no means establish the etiology as being due to iron loss in urine. Iron deficiency developing from the reported level of urine iron excretion is very unlikely. A yearly urinary loss of about 300 mg of iron would occur, but the patient received at least 10 g of iron via transfusion. Since iron deficiency appeared to develop between ages 19 and 22 years, and as it would take at least 25 to 30 years to lose the transfused iron by the reported rate of urinary excretion, it is very likely
Steinberg MH. Sickle Cell Anemia and Iron Deficiency. JAMA. 1982;248(17):2112. doi:10.1001/jama.1982.03330170020008
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