title: Ferritin and LIC: predicting liver injury in children with sickle cell.
abstract: OBJECTIVE
  Chronic blood transfusion therapy reduces clinical events in children with sickle cell anemia but increases risk for an iron-related liver injury. Liver biopsy is the gold standard technique for quantifying liver iron content (LIC) and evaluating liver pathology. Ferritin, liver enzymes, and R2* magnetic resonance imaging of the liver are obtained as surrogate markers. In this study we compared surrogate markers with the gold standard, liver biopsy, in assessing liver histology.
  
  
  METHODS
  We conducted a retrospective review of 259 liver biopsies in 109 children with sickle cell anemia on chronic transfusion therapy and chelation therapy during a 9-year period at a single center. Liver pathology was compared with LIC, ferritin, and alanine aminotransferase.
  
  
  RESULTS
  Ferritin correlates with LIC (r = 0.74, P < 0.001), although there is a broad range of ferritin values for a given LIC. Furthermore, patients with a high LIC (≥7 mg Fe/g dry weight) demonstrated significantly higher ferritin as compared to the patients with lower LIC <7 (P < 0.001). Periportal/portal inflammation also showed a significant relation. There was no significance when comparing ferritin and lobular inflammation or ferritin and alanine aminotransferase. When evaluating LIC in relation to fibrosis, the present study revealed that there was only a significant correlation with severe fibrosis (F = 36, P < 0.001).
  
  
  CONCLUSIONS
  The results suggest that although correlations exist among ferritin and LIC and severe fibrosis and LIC, caution should be taken when they are used in isolation. Liver biopsy provides important pathologic information that cannot be obtained through surrogate markers.
authors.affiliation: *University of Alabama at Birmingham †NYU Langone Medical Center, New York, NY.
authors.forename: Erika
authors.initials: E
authors.lastname: Smith
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lebensburger
authors.forename: Lee
authors.initials: L
authors.lastname: Hilliard
authors.forename: David
authors.initials: D
authors.lastname: Kelly
authors.forename: Naomi
authors.initials: N
authors.lastname: Fineberg
authors.forename: Shuting
authors.initials: S
authors.lastname: Bai
authors.forename: Tom
authors.initials: T
authors.lastname: Howard
mesh_terms: D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000755:Anemia, Sickle Cell / Q000097:blood / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D001706:Biopsy; D015913:Chelation Therapy; D002648:Child; D002675:Child, Preschool; D005293:Ferritins / Q000378:metabolism*; D006801:Humans; D007249:Inflammation / Q000378:metabolism; D007501:Iron / Q000378:metabolism*; D008099:Liver / Q000378:metabolism / Q000473:pathology*; D008103:Liver Cirrhosis / Q000097:blood / Q000209:etiology* / Q000378:metabolism; D012189:Retrospective Studies; D012720:Severity of Illness Index; D065227:Transfusion Reaction; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005293:Ferritins; D007501:Iron; D000410:Alanine Transaminase