Oclusão arterial aguda após infusão inadvertida de sacarato de hidróxido férrico (Noripurum®) na artéria radial: relato de caso
Acute arterial occlusion following inadvertent infusion of ferric hydroxide sacarate (Noripurum®) into the radial artery: case report
Daniel César Magalhães Fernandes; Daniel Rassi Gusmao; Felipe Mendonça Oliveira e Souza; Juliano Ricardo Santana dos Santos; Beatriz Franco Fidalgo
Resumo
Palavras-chave
Abstract
Iron overload, whether acute or chronic, has been implicated in the pathogenesis of ischemic cardiovascular diseases. However, its effects on peripheral vascular function and thrombotic responses to endothelial injury remain incompletely elucidated. We present a case of inadvertent intra-arterial infusion of ferric hydroxide saccharate (Noripurum®), resulting in severe acute arterial occlusion, most likely secondary to diffuse endothelial injury. Despite prompt surgical intervention and adjunctive pharmacological therapy, the clinical outcome was unfavorable. Given the lack of similar reports in major scientific databases and the involvement of complex, yet poorly characterized, interactions between iron overload and endothelial dysfunction, this case contributes valuable insights into the vascular implications of parenteral iron administration.
Keywords
Referências
1 Horwitz LD, Rosenthal EA. Iron-mediated cardiovascular injury. Vasc Med. 1999;4(2):93-9.
2 Edwards CQ. Hemochromatosis and other iron storages disorders. In: Means RT, editor. Wintrobe’s clinical hematology. Philadelphia: Wolters Kluwer; 1993. p. 872-84.
3 Salonen JT, Nyyssönen K, Korpela H, Tuomilehto J, Seppänen R, Salonen R. High stored iron levels are associated with excess risk of myocardial infarction in eastern Finnish men. Circulation. 1992;86(3):803-11.
4 Praticò D, Pasin M, Barry OP, et al. Iron-dependent human platelet activation and hydroxyl radical formation: involvement of protein kinase C. Circulation. 1999;99(24):3118-24.
5 Penn MS, Cui MZ, Winokur AL, et al. Smooth muscle cell surface tissue factor pathway activation by oxidized low-density lipoprotein requires cellular lipid peroxidation. Blood. 2000;96(9):3056-63.
6 Russo G, Leopold JA, Loscalzo J. Vasoactive substances: nitric oxide and endothelial dysfunction in atherosclerosis. Vascul Pharmacol. 2002;38(5):259-69.
7 Day SM, Duquaine D, Mundada LV, et al. Chronic iron administration increases vascular oxidative stress and accelerates arterial thrombosis. Circulation. 2003;107(20):2601-6.
8 Gutteridge JMCHB. Iron and oxygen: a dangerous mixture. Boca Raton: CRC Press; 1990.
9 Gimbrone MA Jr. Vascular endothelium: an integrator of pathophysiologic stimuli in atherosclerosis. Am J Cardiol. 1995;75(6):67B-70B.
10 Epstein FH, Moncada S, Higgs A. The L-arginine-nitric oxide pathway. N Engl J Med. 1993;329(27):2002-12.
11 Asperti M, Vinchi F. Improving CORM technology for the treatment of delayed hemolytic transfusion reaction. HemaSphere. 2024;8(8):e140.
12 Yoshida WB, Rollo HA, Lastória S, et al. Isquemia de membro superior após injeção intramuscular de ampicilina benzatina e dipirona magnésica: relato de um caso. Cir Vasc Angiol. 1999;15:109-15.
13 Duque FLV, Chagas CAA. Acidente por injeção medicamentosa no músculo deltoide: lesões locais e à distância, revisão de 32 casos. J Vasc Bras. 2009;8(3):238-46.
14 Greenwood SA, Beckley-Hoelscher N, Asgari E, et al. The effect of intravenous iron supplementation on exercise capacity in iron-deficient but not anaemic patients with chronic kidney disease: study design and baseline data for a multicentre prospective double-blind randomised controlled trial. BMC Nephrol. 2022;23(1):268.
15 Rooyakkers TM, Stroes ES, Kooistra MP, et al. Ferric saccharate induces oxygen radical stress and endothelial dysfunction in vivo. Eur J Clin Invest. 2002;32(Suppl 1):9-16.
Submetido em:
01/05/2025
Aceito em:
10/12/2025
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email