title: Liver biopsy results in patients with sickle cell disease on chronic transfusions: poor correlation with ferritin levels.
abstract: BACKGROUND
  Chronic transfusions are effective in preventing stroke and other complications of sickle cell disease. The aim of this study was to determine whether serum ferritin levels correlated with liver iron content in sickle cell patients on chronic transfusion.
  
  
  METHODS
  Forty-four liver biopsy specimens from 38 patients with homozygous sickle cell anemia (HbSS) and one patient with sickle thalassemia receiving chronic transfusions were studied. Five patients underwent a second liver biopsy for follow up. Three ferritin measurements were used to calculate a mean for each patient. The association between serum ferritin levels and liver iron quantitation was measured using the Spearman rank correlation, and sensitivity and specificity were determined for selected threshold values of serum ferritin.
  
  
  RESULTS
  Serum ferritin levels ranged from 515 to 6076 ng/ml, liver iron concentration ranged from 1.8 to 67.97 mg/g dry weight. The amount of iron per gram liver dry weight was moderately correlated with serum ferritin values (r = 0.46). The correlation of duration of transfusion with serum ferritin (r = 0.40) and with liver iron content (r = 0.41) also indicated moderate correlation. Liver biopsy results led to changes in the management after 29/44 (66%) of the biopsies. Serum ferritin >/=2500 ng/ml predicted high liver iron content (>/=7 mg/g), with a sensitivity of 62.5% and a specificity of 77.8%.
  
  
  CONCLUSIONS
  We found a poor correlation between serum ferritin levels and liver iron content (LIC). Despite being on chelation therapy, many patients on chronic transfusion had high levels of liver iron. Measurement of LIC is highly recommended in these patients.
authors: Department of Pediatric Gastroenterology, University of Michigan-Medical Center, Ann Arbor, Michigan, USA.
authors: Lina B
authors: LB
authors: Karam
authors: Deborah
authors: D
authors: Disco
authors: Sherron M
authors: SM
authors: Jackson
authors: David
authors: D
authors: Lewin
authors: Virgil
authors: V
authors: McKie
authors: Robert D
authors: RD
authors: Baker
authors: Susan S
authors: SS
authors: Baker
authors: Joseph H
authors: JH
authors: Laver
authors: Paul J
authors: PJ
authors: Nietert
authors: Miguel R
authors: MR
authors: Abboud
mesh_terms: D000755:Anemia, Sickle Cell / Q000150:complications / Q000378:metabolism* / Q000628:therapy; D001707:Biopsy, Needle; D001803:Blood Transfusion; D002648:Child; D005260:Female; D005293:Ferritins / Q000097:blood*; D006486:Hemosiderosis / Q000150:complications; D006801:Humans; D007501:Iron / Q000032:analysis*; D008099:Liver / Q000737:chemistry*; D008297:Male
chemical_list: D005293:Ferritins; D007501:Iron