Iron is not for Iso babies
"On the contrary, iron overload occurs in 70% of neonates with alloimmune HDFN at birth, 50% at the age of 1 month and 18% at the age of 3 months. Therefore, we advise to measure iron status, and we discourage the use of iron supplementation in the first 3 months of life in neonates with alloimmune HDFN. Haemolysis and intrauterine and postnatal transfusions probably both contribute to the high incidence of iron overload in alloimmune HDFN."
70% of iso babies had iron overload at birth, none were iron deficient at birth, 50% at 1 month had iron overload, and 18% had iron overload at 3 months. "There is a number of case reports published on the risk of severe iron overload, diagnosed by liver biopsies, following IUTs for Rh HDFN. These infants were all born at 33 or 34 weeks of gestation and received 2–5 IUTs and several postnatal transfusions. Their serum ferritin levels ranged from 2479 to 28 800 lg/l. In addition to transfusions for alloimmune HDFN, the haemolysis itself can also contribute to iron overload in alloimmune HDFN."
This article also talks about IUTs as a risk factor for choleostasis.https://www.ncbi.nlm.nih.gov/pubmed/23802744
"As discussed above, neonates with RHDN often require IUTs and (multiple) transfusions of red blood cells. The risks and potential consequences of iron overload due to these multiple transfusions are poorly recognized. High levels of cord blood ferritine have been reported in infants with RHDN.57 As infants with RHDN already have high iron storage, supplementation of iron is not recommended and should not be used."
Ylmaz, Şebnem MD*ı; Duman, Nuray MD†; Özer, Esra MD†; Kavas, Nazan MD‡; Ören, Hale MD*; Demircioğlu, Fatih MD*; Kumral, Abdullah MD*; Özkan, Hasan MD†; İrken, Gülersu MD*; Özer, Erdener MD
"A 34 weeks' gestation baby with RHD, who had received multiple intrauterine transfusions (IUT), developed cholestatic hepatic disease and secondary hemophagocytic lymphohistiocytosis (HLH). Her serum ferritin level increased to 5527 ng/mL, and liver biopsy showed severe iron overload. We suggest that patients who have undergone IUT be evaluated for hyperferritinemia."
" Iron therapy is contraindicated in most cases of hemolytic anemia. The reason is that iron released from RBCs in most hemolytic anemias is reused and iron stores are not reduced. "