title: Risk factors for hyperferritinemia secondary to red blood cell transfusions in pediatric cancer patients.
abstract: BACKGROUND
  Transfusion of packed red blood cells is common in pediatric cancer patients who receive chemotherapy. This study was done to identify characteristics of pediatric cancer patients at risk of hyperferritinemia secondary to frequent transfusions.
  
  
  METHODS
  In this retrospective chart review, all pediatric cancer patients who completed chemotherapy from January 2007 to January 2012 and had an assessment of serum ferritin 6 months after the end of treatment were included. Variables included: age, sex, type of cancer diagnosis, weight and body surface area (BSA) at the time of diagnosis, number of transfusions, total transfused volume (TTV), total transfused volume per body weight (TVPBW), and weight and BSA change from the time of diagnosis to the time of ferritin check.
  
  
  RESULTS
  Of 109 eligible patients, 85 (78%) received transfusions. Sixteen patients (14.7%) had ferritin levels > 200 µg/L and four (3.7%) had ferritin levels > 1,000 µg/L. Although age, weight and BSA at cancer diagnosis, number of transfusions and TVPBW were correlated with the level of ferritin, independent risk factors were TTV (range 1,961-30,090 ml in patients with hyperferritinemia, P < 0.001) and BSA change from the time of diagnosis to the time of ferritin check (range -0.15 to 0.31 m(2) in patients with hyperferritinemia, P < 0.001). Increase in BSA was correlated with reduction of hyperferritinemia in follow-up ferritin measurements (P = 0.049).
  
  
  CONCLUSIONS
  In addition to TTV, change in BSA is an independent predictor for the degree and possibly persistence of hyperferritinemia in pediatric cancer patients and should be considered in decisions to initiate interventions.
authors.affiliation: Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada. aamid@cheo.on.ca
authors.forename: Ali
authors.initials: A
authors.lastname: Amid
authors.forename: Nick
authors.initials: N
authors.lastname: Barrowman
authors.forename: Abi
authors.initials: A
authors.lastname: Vijenthira
authors.forename: Pat
authors.initials: P
authors.lastname: Lesser
authors.forename: Karen
authors.initials: K
authors.lastname: Mandel
authors.forename: Raveena
authors.initials: R
authors.lastname: Ramphal
mesh_terms: D000293:Adolescent; D001830:Body Surface Area; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D019189:Iron Metabolism Disorders / Q000097:blood* / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D009369:Neoplasms / Q000097:blood* / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D005293:Ferritins
keywords: cancer; chemotherapy; children; ferritin; iron overload; transfusion