title: Liver iron and serum ferritin levels are misleading for estimating cardiac, pancreatic, splenic and total body iron load in thalassemia patients: factors influencing the heterogenic distribution of excess storage iron in organs as identified by MRI T2*.
abstract: A comparative assessment of excess storage iron distribution in the liver, heart, spleen and pancreas of β-thalassemia major (β-ΤΜ) patients has been carried out using magnetic resonance imaging (MRI) relaxation times T2*. The β-ΤΜ patients (8-40 years, 11 males, 9 females) had variable serum ferritin levels (394-5603 μg/L) and were treated with deferoxamine (n = 10), deferiprone (n = 5) and deferoxamine/deferiprone combination (n = 5). MRI T2* assessment revealed that excess iron is not proportionally distributed among the organs but is stored at different concentrations in each organ and the distribution is different for each β-ΤΜ patient. There is random variation in the distribution of excess storage iron from normal to severe levels in each organ among the β-ΤΜ patients by comparison to the same organs of ten normal volunteers. The correlation of serum ferritin with T2* was for spleen (r = -0.81), liver (r = -0.63), pancreas (r = -0.33) and none with heart. Similar trend was observed in the correlation of liver T2* with the T2* of spleen (r = 0.62), pancreas (r = 0.61) and none with heart. These studies contradict previous assumptions that serum ferritin and liver iron concentration is proportional to the total body iron stores in β-ΤΜ and especially cardiac iron load. The random variation in the concentration of iron in the organs of β-ΤΜ patients appears to be related to the chelation protocol, organ function, genetic, dietary, pharmacological and other factors. Monitoring of the iron load for all the organs is recommended for each β-ΤΜ patient.
authors.affiliation: Postgraduate Research Institute of Science, Technology, Environment and Medicine, Limassol, Cyprus.
authors.forename: Annita
authors.initials: A
authors.lastname: Kolnagou
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Natsiopoulos
authors.forename: Marios
authors.initials: M
authors.lastname: Kleanthous
authors.forename: Alexia
authors.initials: A
authors.lastname: Ioannou
authors.forename: George J
authors.initials: GJ
authors.lastname: Kontoghiorghes
mesh_terms: D000293:Adolescent; D000328:Adult; D001822:Body Burden; D002648:Child; D000077543:Deferiprone; D003676:Deferoxamine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005293:Ferritins / Q000097:blood*; D006801:Humans; D007501:Iron / Q000032:analysis / Q000378:metabolism*; D007502:Iron Chelating Agents / Q000627:therapeutic use; D019190:Iron Overload / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism; D008099:Liver / Q000737:chemistry / Q000378:metabolism*; D008279:Magnetic Resonance Imaging; D008297:Male; D009206:Myocardium / Q000737:chemistry / Q000378:metabolism*; D020799:Pancrelipase / Q000737:chemistry / Q000378:metabolism*; D011728:Pyridones / Q000627:therapeutic use; D013154:Spleen / Q000737:chemistry / Q000378:metabolism*; D055815:Young Adult; D017086:beta-Thalassemia / Q000150:complications / Q000188:drug therapy / Q000378:metabolism*
chemical_list: D007502:Iron Chelating Agents; D011728:Pyridones; D000077543:Deferiprone; D020799:Pancrelipase; D005293:Ferritins; D007501:Iron; D003676:Deferoxamine