ArticleClinics and practice2020
COVID-19: hemoglobin, iron, and hypoxia beyond inflammation. A narrative review.
Article in Clinics and practice, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 242 papers, 6 of them syntheses that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
242 citing papers in PubMed, 6 syntheses or guidelines pooled it, 430 citations in OpenAlex.
- The Relationship Between Hepcidin-Mediated Iron Dysmetabolism and COVID-19 Severity: A Meta-Analysis.Frontiers in public health · 2022Pooled it
- Oral Manifestations of COVID-19 in Hospitalized Patients: A Systematic Review.International journal of environmental research and public health · 2021Pooled it
- The Role of Nutrition in COVID-19 Susceptibility and Severity of Disease: A Systematic Review.The Journal of nutrition · 2021Pooled it
- Pooled it
- Tocilizumab administration is associated with the reduction in biomarkers of coronavirus disease 2019 infection.Journal of medical virology · 2021Pooled it
- Global prevalence of prolonged gastrointestinal symptoms in COVID-19 survivors and potential pathogenesis: A systematic review and meta-analysis.F1000Research · 2021Pooled it
- Analysis of blood biomarkers and sports performance in crossfit athletes using the elevation training mask 2.0 post SARS-CoV-2 infection.Scientific reports · 2025Trial
- Efficacy and safety of licorice (Glycyrrhiza glabra) in moderately ill patients with COVID-19: a randomized controlled trial.Inflammopharmacology · 2023Trial
- The Prospect of Lactoferrin Use as Adjunctive Agent in Management of SARS-CoV-2 Patients: A Randomized Pilot Study.Medicina (Kaunas, Lithuania) · 2021Trial
- PEDV envelope protein promotes viral replication by remodeling host iron homeostasis via the TRIM28-KLF15-FPN axis.Journal of virology · 2026Article
- High levels of cell-free hemoglobin and iron in cerebral thrombi of pre-Omicron COVID-19 stroke patients: novel drivers of SARS-CoV-2-induced prothrombotic state.Acta neuropathologica · 2026Article
- Plasma Membrane Redox Failure Links COVID-19 Metabolic Stress to Ferroptotic Neurodegeneration.Antioxidants (Basel, Switzerland) · 2026Review
- Genetic polymorphisms and expression of SARS-CoV-2 host entry genes associate with COVID-19 severity in an unvaccinated Moroccan cohort.BMC medical genomics · 2026Article
- Article
- Comparison ofJournal of clinical medicine · 2025Article
- Association of Markers of iron Metabolism with Mucormycosis: A Case Control Study.Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India · 2025Article
- Chronic Obstructive Pulmonary Disease and COVID-19: The Impact of Hematological Biomarkers on Disease Severity and Outcomes.Journal of clinical medicine · 2025Review
- Article
- Pathology of Red Blood Cells in Patients with SARS-CoV-2.Biomedicines · 2025Article
- Article
182 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Coronavirus disease-19 (COVID-19) has been regarded as an infective-inflammatory disease, which affects mainly lungs. More recently, a multi-organ involvement has been highlighted, with different pathways of injury. A hemoglobinopathy, hypoxia and cell iron overload might have a possible additional role. Scientific literature has pointed out two potential pathophysiological mechanisms: i) severe acute respiratory syndrome-coronavirus-2 (SARS-CoV- 2) interaction with hemoglobin molecule, through CD147, CD26 and other receptors located on erythrocyte and/or blood cell precursors; ii) hepcidin-mimetic action of a viral spike protein, inducing ferroportin blockage. In this translational medicinebased narrative review, the following pathologic metabolic pathways, deriving from hemoglobin denaturation and iron metabolism dysregulation, are highlighted: i) decrease of functioning hemoglobin quote; ii) iron overload in cell/tissue (hyperferritinemia); iii) release of free toxic circulating heme; iv) hypoxemia and systemic hypoxia; v) reduction of nitric oxide; vi) coagulation activation; vii) ferroptosis with oxidative stress and lipoperoxidation; viii) mitochondrial degeneration and apoptosis. A few clinical syndromes may follow, such as pulmonary edema based on arterial vasoconstriction and altered alveolo-capillary barrier, sideroblastic-like anemia, endotheliitis, vasospastic acrosyndrome, and arterio- venous thromboembolism. We speculated that in COVID-19, beyond the classical pulmonary immune-inflammation view, the occurrence of an oxygen-deprived blood disease, with iron metabolism dysregulation, should be taken in consideration. A more comprehensive diagnostic/therapeutic approach to COVID-19 is proposed, including potential adjuvant interventions aimed at improving hemoglobin dysfunction, iron over-deposit and generalized hypoxic state.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.