Serum ferritin level changes in children with sickle cell disease on chronic blood transfusion are nonlinear and are associated with iron load and liver injury.
Chronic blood transfusion is increasingly indicated in patients with sickle cell disease. Measuring resulting iron overload remains a challenge. Children without viral hepatitis enrolled in 2 trials for stroke prevention were examined for iron overload (STOP and STOP2; n = 271). Most received desferrioxamine chelation. Serum ferritin (SF) changes appeared nonlinear compared with prechelation estimated transfusion iron load (TIL) or with liver iron concentrations (LICs). Averaged correlation coefficient between SF and TIL (patients/observations, 26 of 164) was r = 0.70; between SF and LIC (patients/observations, 33 of 47) was r = 0.55. In mixed models, SF was associated with LIC (P = .006), alanine transaminase (P = .025), and weight (P = .026). Most patients with SF between 750 and 1500 ng/mL had a TIL between 25 and 100 mg/kg (72.8% +/- 5.9%; patients/observations, 24 of 50) or an LIC between 2.5 and 10 mg/g dry liver weight (75% +/- 0%; patients/observations, 8 of 9). Most patients with SF of 3000 ng/mL or greater had a TIL of 100 mg/kg or greater (95.3% +/- 6.7%; patients/observations, 7 of 16) or an LIC of 10 mg/g dry liver weight or greater (87.7% +/- 4.3%; patients/observations, 11 of 18). Although SF changes are nonlinear, levels less than 1500 ng/mL indicated mostly acceptable iron overload; levels of 3000 ng/mL or greater were specific for significant iron overload and were associated with liver injury. However, to determine accurately iron overload in patients with intermediately elevated SF levels, other methods are required. These trials are registered at www.clinicaltrials.gov as #NCT00000592 and #NCT00006182.
Adamkiewicz
Thomas V
TV
Morehouse School of Medicine, Atlanta, GA 30344, USA. tadamkiewicz@msm.edu
Abboud
Miguel R
MR
Paley
Carole
C
Olivieri
Nancy
N
Kirby-Allen
Melanie
M
Vichinsky
Elliott
E
Casella
James F
JF
Alvarez
Ofelia A
OA
Barredo
Julio C
JC
Lee
Margaret T
MT
Iyer
Rathi V
RV
Kutlar
Abdullah
A
McKie
Kathleen M
KM
McKie
Virgil
V
Odo
Nadine
N
Gee
Beatrice
B
Kwiatkowski
Janet L
JL
Woods
Gerald M
GM
Coates
Thomas
T
Wang
Winfred
W
Adams
Robert J
RJ
D000410:Alanine Transaminase; D000755:Anemia, Sickle Cell / Q000097:blood* / Q000150:complications; D019540:Area Under Curve; D002648:Child; D003676:Deferoxamine / Q000627:therapeutic use; D005293:Ferritins / Q000097:blood*; D006801:Humans; D019190:Iron Overload / Q000209:etiology*; D008099:Liver / Q000378:metabolism / Q000473:pathology; D008103:Liver Cirrhosis / Q000097:blood / Q000209:etiology*; D012372:ROC Curve; D017262:Siderophores / Q000627:therapeutic use; D020521:Stroke / Q000517:prevention & control; D065227:Transfusion Reaction
D017262:Siderophores; D005293:Ferritins; D000410:Alanine Transaminase; D003676:Deferoxamine