Biochemical and hematological changes in low-level aluminum intoxication

The aim of this study was to investigate the biochemical and hematological changes in patients on routine hemodialysis treatment when they were accide ntally exposed to moderately high serum aluminum concentrations during a pe riod of time of less than four months. We studied the changes in biochemica l and hematological measurements in 33 patients on dialysis in our hospital before and during the exposure to about 0.85 mu mol/l of aluminum in dialy sis water due to a malfunction of the reverse osmosis system of water purif ication. Patients showed a decrease in the hemoglobin concentration from 11 5 +/- 12.4 g/l to 108 +/- 12.2 g/l (p=0.026) and in the mean corpuscular he moglobin concentration from 5.15 +/- 0.22 to 5.02 +/- 0.30 mmol/l (p=0.014) . Ferritin was decreased from 243 +/- 192 mu g/l to 196 +/- 163 mu g/l (p=0 .047) and transferrin saturation from 0.20 +/- 0.06 to 0.15 +/- 0.07 (p=0.0 04). Biochemical measurements related to calcium-phosphate metabolism did n ot change. Otherwise, all patients showed an increase in serum aluminum fro m 0.56 +/- 0.44 to 1.63 +/- 0.52 mu mol/l (p<0.001). No differences were de tected in serum aluminum between patients receiving and not receiving oral aluminum salts. Even moderately high aluminum concentrations maintained dur ing a short period of time could produce significant hematological alterati ons and a depletion of body iron stores before clinical manifestations were evident.