title: Number of erythrocyte transfusions is more predictive than serum ferritin in estimation of cardiac iron loading in pediatric patients with acute lymphoblastic leukemia.
abstract: BACKGROUND
  Transfusions with packed erythrocytes is a common practice in pediatric patients with acute lymphoblastic leukemia (ALL) who are on chemotherapy. Since there is no physiological excretion mechanism for iron, the iron related to erythrocyte transfusions accumulates and may contribute to late cardiac, hepatic and endocrine complications in these patients.
  
  
  METHODS
  In order to evaluate the iron burden among pediatric patients with ALL and define the risk factors associated with higher iron loading, we evaluated 79 pediatric patients with ALL (36 were off-therapy). Cardiac and hepatic T2* were ordered to a total of 22 (28%) patients who were either transfused with erythrocytes ≥ 10 times (n=11; 50%), had serum ferritin (SF) ≥ 1000 ng/ml (n=2; 9.1%) or both (n=9; 40.9%).
  
  
  RESULTS
  Half of the patients who were screened by T2* MRI had hepatic T2*<7 ms and six (27%) of the patients had cardiac T2*<20 ms, indicating iron loading. Patients who had serum ferritin <1000 vs ≥ 1000 ng/ml had median cardiac T2* values of 28.3 ms (15-40) vs 21 (7.9-36), (p=0.324); whereas hepatic T2* of 10.8 (5.32-27) vs 4.7 (2.2-36), (p=0.017). Patients who had erythrocyte transfusion <10 vs ≥ 10 times had median cardiac T2* values of 34 ms (28-38) vs 23 (7.93-40), (p=0.021); whereas hepatic T2* of 13.6 (6.6-36) vs 5.32 (2.2-27), (p=0.046).
  
  
  CONCLUSIONS
  Our results indicate that pediatric patients with ALL should be screened for transfusional iron load and the amount of erythrocyte transfusions seems to be a more reliable indication than serum ferritin levels to detect cardiac iron loading in these patients.
authors.affiliation: Hacettepe University, Division of Pediatric Hematology, Ankara, Turkey. Electronic address: suleunal@hacettepe.edu.tr.
authors.forename: Sule
authors.initials: S
authors.lastname: Unal
authors.affiliation: Hacettepe University, Division of Pediatric Hematology, Ankara, Turkey.
authors.forename: Mualla
authors.initials: M
authors.lastname: Cetin
authors.affiliation: Hacettepe University, Department of Radiology, Ankara, Turkey.
authors.forename: Tuncay
authors.initials: T
authors.lastname: Hazirolan
authors.affiliation: Hacettepe University, Department of Radiology, Ankara, Turkey.
authors.forename: Gokce
authors.initials: G
authors.lastname: Yildirim
authors.affiliation: Hacettepe University, Department of Pediatrics, Ankara, Turkey.
authors.forename: Aytac
authors.initials: A
authors.lastname: Meral
authors.affiliation: Hacettepe University, Department of Pediatrics, Ankara, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Birbilen
authors.affiliation: Hacettepe University, Department of Biostatistics, Ankara, Turkey.
authors.forename: Erdem
authors.initials: E
authors.lastname: Karabulut
authors.affiliation: Hacettepe University, Division of Pediatric Hematology, Ankara, Turkey.
authors.forename: Selin
authors.initials: S
authors.lastname: Aytac
authors.affiliation: Hacettepe University, Division of Pediatric Hematology, Ankara, Turkey.
authors.forename: Betul
authors.initials: B
authors.lastname: Tavil
authors.affiliation: Hacettepe University, Division of Pediatric Hematology, Ankara, Turkey.
authors.forename: Baris
authors.initials: B
authors.lastname: Kuskonmaz
authors.affiliation: Hacettepe University, Division of Pediatric Hematology, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Tuncer
authors.affiliation: Hacettepe University, Division of Pediatric Hematology, Ankara, Turkey.
authors.forename: Fatma
authors.initials: F
authors.lastname: Gumruk
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D005293:Ferritins / Q000097:blood*; D006801:Humans; D007223:Infant; D007501:Iron / Q000378:metabolism*; D019190:Iron Overload / Q000175:diagnosis* / Q000209:etiology; D008099:Liver / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D011237:Predictive Value of Tests; D011379:Prognosis; D055815:Young Adult
chemical_list: D005293:Ferritins; D007501:Iron
keywords: ALL; Cardiac; Hepatic; Iron; MRI; Pediatric