title: Iron overload in Brazilian thalassemic patients.
abstract: ABSTRACTObjectives:To evaluate the use of magnetic resonance imaging in patients with β-thalassemia and to compare T2* magnetic resonance imaging results with serum ferritin levels and the redox active fraction of labile plasma iron.
  
  
  METHODS
  We have retrospectively evaluated 115 chronically transfused patients (65 women). We tested serum ferritin with chemiluminescence, fraction of labile plasma iron by cellular fluorescence and used T2* MRI to assess iron content in the heart, liver, and pancreas. Hepatic iron concentration was determined in liver biopsies of 11 patients and the results were compared with liver T2* magnetic resonance imaging.
  
  
  RESULTS
  The mean serum ferritin was 2,676.5 +/- 2,051.7 ng/mL. A fraction of labile plasma iron was abnormal (> 0,6 Units/mL) in 48/83 patients (57%). The mean liver T2* value was 3.91 ± 3.95 ms, suggesting liver siderosis in most patients (92.1%). The mean myocardial T2* value was 24.96 ± 14.17 ms and the incidence of cardiac siderosis (T2* < 20 ms) was 36%, of which 19% (22/115) were severe cases (T2* < 10 ms). The mean pancreas T2* value was 11.12 ± 11.20 ms, and 83.5% of patients had pancreatic iron deposition (T2* < 21 ms). There was significant curvilinear and inverse correlation between liver T2* magnetic resonance imaging and hepatic iron concentration (r= -0.878; p < 0.001) and moderate correlation between pancreas and myocardial T2* MRI (r = 0.546; p < 0.0001).
  
  
  CONCLUSIONS
  A high rate of hepatic, pancreatic and cardiac impairment by iron overload was demonstrated. Ferritin levels could not predict liver, heart or pancreas iron overload as measured by T2* magnetic resonance imaging. There was no correlation between liver, pancreas, liver and myocardial iron overload, neither between ferritin and fraction of labile plasma iron with liver, heart and pancreas T2* values.
authors.affiliation: Hospital Israelita Albert Einstein - HIAE, São Paulo, BR.
authors.forename: Reijane Alves de
authors.initials: RA
authors.lastname: Assis
authors.affiliation: Department of Imaging, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR.
authors.forename: Fernando Uliana
authors.initials: FU
authors.lastname: Kay
authors.affiliation: Department of Imaging, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR.
authors.forename: Laércio Alberto
authors.initials: LA
authors.lastname: Rosemberg
authors.affiliation: Department of Imaging, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR.
authors.forename: Alexandre Henrique C
authors.initials: AH
authors.lastname: Parma
authors.affiliation: Department of Imaging, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR.
authors.forename: Cesar Higa
authors.initials: CH
authors.lastname: Nomura
authors.affiliation: Centro de Hematologia de São Paulo - CHSP, São Paulo, SP, BR.
authors.forename: Sandra Regina
authors.initials: SR
authors.lastname: Loggetto
authors.affiliation: Pernambuco Blood Center, Recife, PE, BR.
authors.forename: Aderson da Silva
authors.initials: Ada S
authors.lastname: Araujo
authors.affiliation: Marilia Blood Center, Marilia, SP, BR.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fabron Junior
authors.affiliation: Boldrini Children Center, Campinas, SP, BR.
authors.forename: Mônica Pinheiro de Almeida
authors.initials: MP
authors.lastname: Veríssimo
authors.affiliation: Parana Blood Center - HEMEPAR, Curitiba, PR, BR.
authors.forename: Giorgio Roberto
authors.initials: GR
authors.lastname: Baldanzi
authors.affiliation: Brazilian Association of Thalassemia - ABRASTA, São Paulo, SP, BR.
authors.forename: Merula A
authors.initials: MA
authors.lastname: Steagal
authors.affiliation: Brazilian Association of Thalassemia - ABRASTA, São Paulo, SP, BR.
authors.forename: Claudia Angela Galleni Di Sessa
authors.initials: CA
authors.lastname: Velloso
authors.affiliation: Chemistry Institute, Universidade de São Paulo - USP, São Paulo, 'SP, BR.
authors.forename: Breno Pannia
authors.initials: BP
authors.lastname: Espósito
authors.affiliation: Instituto Israelita de Ensino e Pesquisa Albert Einstein - IIEPAE, São Paulo, SP, BR.
authors.forename: Sandra Saemi
authors.initials: SS
authors.lastname: Nakashima
authors.affiliation: Instituto Israelita de Ensino e Pesquisa Albert Einstein - IIEPAE, São Paulo, SP, BR.
authors.forename: Michelli da Silva
authors.initials: Mda S
authors.lastname: Diniz
authors.affiliation: Clinical Trials Department Apotex, Toronto, CA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Tricta
authors.affiliation: Department of Imaging, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR.
authors.forename: Ronaldo Hueb
authors.initials: RH
authors.lastname: Baroni
authors.affiliation: Department of Imaging, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR.
authors.forename: Marcelo Buarque de Gusmão
authors.initials: MB
authors.lastname: Funari
authors.affiliation: Childrens Hospital of Los Angeles, Los Angeles, US.
authors.forename: John C
authors.initials: JC
authors.lastname: Wood