scholarly journals Setting for “Normal” Serum Ferritin Levels in Patients with Transfusion-Dependent Thalassemia: Our Current Strategy

2021 ◽  
Vol 10 (24) ◽  
pp. 5985
Author(s):  
Anna Spasiano ◽  
Antonella Meloni ◽  
Silvia Costantini ◽  
Emilio Quaia ◽  
Filippo Cademartiri ◽  
...  

This cross-sectional study aimed to establish the association between serum ferritin levels and organ iron overload (IO) and overall morbidity in transfusion-dependent thalassemia (TDT) patients. One hundred and three TDT patients (40.03 ± 9.15 years; 57.3% females) with serum ferritin < 2500 ng/mL were included. IO was assessed by T2* magnetic resonance imaging. Three groups were identified based on mean serum ferritin levels: <500 ng/mL (group 0; N = 32), 500–1000 ng/mL (group 1; N = 43), and 1000–2500 ng/mL (group 2; N = 28). All demographic and biochemical parameters were comparable among the three groups, with the exception of the triglycerides being significantly lower in group 0 than in group 2. No difference was found in the frequency of hepatic, endocrine, and cardiac complications. Hepatic IO was significantly less frequent in group 0 versus both groups 1 and 2. No patient with a serum ferritin level < 500 ng/mL had significant myocardial IO and alterations in the main hematological parameters. No difference in the distribution of the different chelation regimens was found. Serum ferritin < 500 ng/mL appears to be achievable and safe for several TDT patients. This target is associated with the absence of significant cardiac iron and significantly lower hepatic IO and triglycerides that are well-demonstrated markers for cardiac and liver complications.

2021 ◽  
Vol 9 (B) ◽  
pp. 144-148
Author(s):  
Khalaf Hussein Hasan ◽  
Aspazija Sofijanova ◽  
Luma Hassan ◽  
Nasir Al-Allawi

BACKGROUND: The introduction of deferasirox as an oral iron chelator for hemoglobinopathies has been hailed by many as an important milestone in the management of iron overload in the latter disorders. AIM: The objectives of the study were to evaluate the effectiveness of deferasirox in patients with hemoglobinopathies and to assess predictors of response. METHODS: In this cross-sectional study, 160 patients diagnosed with hemoglobinopathies were included retrospectively from Jin hematology and oncology center in Duhok city, Iraqi Kurdistan. The Jin center offers patients with hemoglobinopathies clinical advice, examination, follow-up, treatment, and blood transfusions. RESULTS: The median age of enrolled patients was 12 years (range 3–34 years), and included 86 females and 74 males. All patients were on deferasirox with a compliance rate of 77.5%. Furthermore, 32.3% were on concomitant deferoxamine at their last follow-up. After a median follow-up of 2.1 years (range 1–4 years), there was a mean reduction of serum ferritin level of −478.7 overall and −821.1 ng/ml in complaint patients (both being significant at p of 0.042 and 0.001, respectively). Univariate analysis revealed that older age at enrollment, and older age at starting therapy, and initial serum ferritin (>3000 ng/ml) were all significantly associated with more mean reduction in serum ferritin; while only the latter remained so by multivariate analysis (p = 0.04). CONCLUSIONS: Deferasirox was found to be effective in reducing the level of serum ferritin among this cohort of hemoglobinopathy patients, to a degree comparable to that reported in other studies worldwide. Furthermore, there were significant associations between the reduction of serum ferritin level and age, age at starting treatment, drug compliance, and the initial serum ferritin levels.


2021 ◽  
Vol 9 (02) ◽  
pp. 56-60
Author(s):  
Rajendra Kumar Chaudhari ◽  
Apeksha Niraula ◽  
Basanta Gelal ◽  
Jouslin Kishore Baranwal ◽  
Deependra Prasad Sarraf ◽  
...  

INTRODUCTION: Type 2 diabetes mellitus is a metabolic disorder of multiple etiology characterized by chronic hyperglycemia with a derangement in carbohydrate, fat and protein metabolism resulting from defects in insulin secretion and action. Ferritin is a ubiquitous intracellular protein complex that reflects the iron stores of the body. Studies have shown that the increased body iron stores are associated with the development of glucose intolerance often leading to metabolic syndrome and type 2 diabetes (T2DM). The objective of the study was to find out association of serum ferritin level with T2DM and assess the correlation between serum ferritin and HbA1c. MATERIAL AND METHODS: A hospital based comparative cross-sectional study was conducted in 43 diabetic patients and 42 age and sex matched healthy controls. Fasting blood glucose (FBG), postprandial blood glucose (PBG), Glycated hemoglobin (HbA1c) and serum ferritin were estimated in cobas c311 autoanalyser using standard protocol. RESULTS: Mean age of healthy control and T2DM were found 54.83 ± 6.48 and 55.95±10.92 years respectively. Mean FBG (mg/dL) (170.41 ± 71.7 v/s 98.38 ± 9.7), PBG (mg/dL) (266.16 ± 110.09 v/s 123.20 ± 17.0), HbA1c (%) (8.17 ± 1.83 v/s 4.9 ± 0.29 and median ferritin (μg/L) 207.90 (138, 306.0) v/s 127.95 (85.75, 210.25) were significantly higher in T2DM compared to the healthy controls. Spearman’s correlation depicted that ferritin level was positively correlated with HbA1c level but the correlation was statistically insignificant. CONCLUSION: Serum ferritin level was found significantly higher in T2DM compared to healthy age and sex matched controls in our study.


2018 ◽  
Vol 96 (12) ◽  
pp. 1255-1260
Author(s):  
Harshitha Hitha ◽  
Damodara Gowda ◽  
Amrit Mirajkar

The aim of this study was to investigate the relationship between serum ferritin level and antioxidative status and metabolic dysregulation in young adult obese population. This cross-sectional study included 300 subjects of either sex, grouped as obese and non-obese subjects. The body mass index, total iron binding capacity, fasting blood glucose, superoxide dismutase activity, and levels of serum ferritin, iron, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, glutathione, and vitamin C were estimated. Analysis showed a significant alteration in all the parameters in obese adults. The correlation of ferritin level and body mass index showed a positive correlation (r = −0.81, p < 0.001, respectively) with levels of fasting blood glucose, superoxide dismutase, total cholesterol, low-density lipoprotein cholesterol, and triglyceride in obese individuals, whereas an insignificant correlation with vitamin C and glutathione level was observed in obese individuals. The significant positive correlation of ferritin level with the metabolic parameters and some antioxidative parameters in obese individuals signifies the development of metabolic disorders. Therefore, estimation of serum ferritin level will be an important early indicator for the risk of developing metabolic disorders in young adults.


2020 ◽  
Vol 4 (1) ◽  
pp. 16-18
Author(s):  
Khaza Amirul Islam ◽  
Md. Shafiul Azam ◽  
Nishat Mahzabin ◽  
Md. Rafiquzzaman Khan ◽  
Md. Salahuddin Shah ◽  
...  

The aim of the study was to determine the frequency of hypothyroidism in transfusion dependent thalassaemia patients. A total of 64 transfusion dependent thalassaemia (TDT) patients were included in this cross-sectional study from April, 2018 to September, 2019 according to selection criteria. Thyroid hormone status was assessed by estimation of serum FT4 and serum TSH. Body iron load was estimated by serum ferritin level. The study sample consisted of 43 male and 21 female TDT patients, with a mean age of 25.5 years. Total 28% patients were found hypothyroid, 11% were overt hypothyroid and 17% were subclinical hypothyroid. Mean serum ferritin level was 2462.6 ng/ml. Significant correlation was not found between serum TSH and Serum ferritin level (p = 0.055). Total unit of transfusion (p=0.001) and duration of transfusion therapy (p=0.003) were significantly associated with development of hypothyroidism.


2019 ◽  
Vol 6 (5) ◽  
pp. 2081
Author(s):  
Santosh K. Shukla ◽  
Anubha Shrivastava ◽  
Prakash C. Mishra

Background: Ongoing transfusional iron load (TIL) is an important determinant while deciding starting and subsequent dose adjustment of deferasirox during course of chelation therapy. So present study aims to find out effect of different dosing of deferasirox over the serum ferritin level in children with thalassemia major with impact of rate of transfusional iron load.Methods: This one year observational study was carried out in 35 transfusion dependent β-thalassemic patients aged 2-18 years. Patients with baseline serum ferritin 1000-1500ng/ml and/or receiving TIL 0.2-0.3mg/kg/day were started 20mg/kg/day deferasirox and patients with ferritin>1500ng/ml and/or having TIL > 0.3mg/kg/day were started 30mg/kg/day deferasirox. Serum ferritin was repeated in every three months. Dose adjustments were performed on serum ferritin trends in steps of 5-10mg/kg /day to maximum 40mg/kg/day. Evaluation of relationship between dose adjustment, percentage of reduction in serum ferritin and TIL was done.Results: Group-1 patients(42.8%) had TIL 0.2 to 0.3mg/kg/day whereas Group-2(37.1%) and Group-3(20%) children had TIL >0.3-0.4mg/kg/day and >0.4 mg/kg/day respectively. Starting dose of deferasirox in 25.7% patients was 20mg/kg/day and in rest were 30mg/kg/day. Average dose of deferasirox in group-1 was significantly lower as compared to group-2 and group-3 patients ( p< 0.05). Significant decline in mean serum ferritin was observed in all three groups (p < 0.05). There was a significant positive correlation between TIL and average drug dose prescribed (r=0.5411and p=0.0007) but negative insignificant correlation was observed with percentage of reduction in serum ferritin(r=0.0027and p=0.98).Conclusions: Deferasirox 30mg/kg/day significantly reduces serum ferritin and is well tolerated in majority of patients having TIL 0.3-0.4mg/kg/day where as 20mg/kg/day is required in patients having low transfusional iron intake.


2016 ◽  
Vol 43 (1) ◽  
pp. 24
Author(s):  
Fajar Subroto ◽  
Bulan Ginting Munthe ◽  
Najib Advani ◽  
Agus Firmansyah

Background Patients with b-thalassemia major, long-term trans-fusion, extravasal hemolytic, and increased intestinal absorptionof iron result in systemic iron overload, which may accumulate inmyocardium causing cardiac dysfunctions. Congestive heart fail-ure usually develops in adolescence or early adult years, and pa-tient usually dies within 1 year after the onset of symptoms. There-fore, it is important to detect early signs of cardiac dysfunction inpatient with thalassemia.Objective This study aimed to assess the correlation betweenferritin level and cardiac dysfunction in patients with thalassemia.Methods A cross sectional study was conducted on 62 b-thalas-semic patients (34 males and 28 females) with age ranging from3.5 to 23 years. They received 3,150 – 94,985 mL of blood; withthe serum ferritin level of 812.2 – 12,175 ng/mL. Each patient un-derwent laboratory examinations and clinical cardiac evaluationwith ECG and echocardiography.Results Cumulative blood transfusions correlated well with theserum ferritin values (p=0.001). The serum ferritin level did notshow correlation with deferoxamine (DFO) treatment. ECG exami-nation revealed 5 patients (8.1%) with dysrhythmia, LVH, and heartblock grade II and I. Echocardiography examination showed 18patients (29%) with systolic or diastolic dysfunction. There was nocorrelation between the serum ferritin level and cardiac dysfunc-tions (p=0.640). The serum ferritin prediction value against car-diac dysfunctions could not be established.Conclusion There was no correlation between serum ferritin lev-els with cardiac dysfunctions. In detecting cardiac dysfunctions inthalassemic patients, echocardiography was more sensitive thanECG


2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Ahlam M. Ismail ◽  
Mostafa Ahmed El Sayed Ahmed Abu Elela ◽  
Islam Nashaat Roshdy Ahmed ◽  
Nagwa Mohamed Sabry Mahmoud

Background: Sepsis still causes morbidity and mortality in children admitted to the pediatric intensive care unit (PICU). Sepsis induces myocardial dysfunction and causes a reversible decline in ejection fraction (EF) of ventricles. Many biomarkers have been described for diagnosing sepsis, including serum ferritin and C-reactive protein (CRP). Objectives: This study was conducted to assess the relationship of cardiac dysfunction evaluated using echocardiogram, ferritin, and CRP with negative outcomes of sepsis in the PICU. Methods: A cross-sectional study was conducted on 80 patients aged between one month and six years who fulfilled the following criteria: (1) confirmed diagnosis of sepsis according to the American College of Critical Care Medicine; (2) receiving ventilation for 48 h and/or vasoactive medicines. The CRP and ferritin levels were recorded on the first day (D1) and third day (D3) of hospitalization in the PICU. Participants underwent an echocardiography study to investigate the ejection fraction on D1 and D3. All outcomes were evaluated. Results: Our results showed a highly statistically significant difference between D1 and D3 in ejection fraction (P = 0.001). The serum ferritin level and CRP enhanced significantly from D1 to D3 (P < 0.001). Low left ventricular ejection fraction, and high serum ferritin were associated with unfavorable outcomes (P values < 0.001 and 0.021, respectively), but there was no significant difference in the outcomes regarding CRP. Conclusions: Cardiac dysfunction and high serum ferritin were associated with unfavorable outcomes in children with sepsis admitted to the PICU.


e-CliniC ◽  
2020 ◽  
Vol 8 (2) ◽  
Author(s):  
Ribka Wowor

Abstract: Inflammation process that occurs in obese people plays a crucial role for cardiovascular events in the future. Animal studies found an association between macrophage and ferritin as a proinflammatory marker. This study was aimed to determine the difference in serum ferritin level between central obese and non central obese individuals. This was a cross sectional study using consecutive sampling mnethod. Subjects were residents of Medical Faculty, Sam Ratulangi University, consisted of 41 young males divided into two groups: 25 subjects with central obesity and 16 subjects without central obesity. Blood pressure, peripheral blood, serum ferritin, creatinine, and fasting blood sugar tests were performed on all subjects. The results showed that of 25 subjects with central obesity, there were 15 subjects with hyperferritinemia, meanwhile only 3 subjects with hyperferritinemia in non central obesity group. There was a significant difference of mean serum ferritin levels between central obesity and non central obesity groups (303.03±171.53 mcg/dL vs 128.24±66.79 mcg/dL; p=0.000). In conclusion, serum ferritin level in male subjects with central obesity was higher than those without central obesity.Keywords: serum ferritin, central obesity Abstrak: Inflamasi yang terjadi pada obesitas berperan penting terhadap kelainan metabolisme yang menjadi dasar terjadinya kelainan kardiovaskular. Pada hewan coba didapatkan adanya hubungan antara makrofag dengan feritin yang merupakan salah satu protein penanda inflamasi akut dan kronis. Penelitian ini bertujuan untuk mengetahui adanya perbedaan rerata ferritin serum pada individu dengan dan tanpa obesitas sentral. Desain penelitian ialah potong lintang dengan menggunakan konsekutif sampling. Subyek penelitian ialah mahasiswa PPDS Sp1 Fakultas Kedokteran Universitas Sam Ratulangi Manado terdiri dari 41 pria usia dewasa muda berusia kurang dari 40 tahun yang dibagi atas dua kelompok: 25 subyek dengan obesitas sentral dan 16 subyek non obesitas sentral sebagai kontrol. Pemeriksaan tekanan darah, darah perifer lengkap, dan kadar feritin serum dilakukan pada semua subyek. Uji statistik menggunakan uji beda rerata antara kadar feritin pada kedua kelompok. Hasil penelitian mendapatkan pada kelompok obesitas sentral, 15 dari 25 subyek mengalami peningkatan kadar feritin serum, sedangkan pada kelompok non obesitas sentral hanya 3 dari 16 subyek yang mengalami peningkatan kadar feritin serum. Rerata feritin serum pada kelompok obesitas sentral ialah 303,03±171,53 mcg/dL; sedangkan pada kelompok non obesitas sentral ialah 128,24±66,79 mcg/dL (p=0,000). Simpulan penelitian ini ialah terdapat perbedaan rerata feritin serum antara subyek dengan obesitas sentral dibandingkan subyek non obesitas sentral pada pria dewasa muda.Kata kunci: feritin serum, obesitas sentral, dewasa muda


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