Einstein (São Paulo) (Jun 2011)

Iron overload in Brazilian thalassemic patients

  • Reijane Alves de Assis,
  • Fernando Uliana Kay,
  • Laércio Alberto Rosemberg,
  • Alexandre Henrique C. Parma,
  • Cesar Higa Nomura,
  • Sandra Regina Loggetto,
  • Aderson da Silva Araujo,
  • Antonio Fabron Junior,
  • Mônica Pinheiro de Almeida Veríssimo,
  • Giorgio Roberto Baldanzi,
  • Merula A. Steagal,
  • Claudia Angela Galleni Di Sessa Velloso,
  • Breno Pannia Espósito,
  • Sandra Saemi Nakashima,
  • Michelli da Silva Diniz,
  • Fernando Tricta,
  • Ronaldo Hueb Baroni,
  • Marcelo Buarque de Gusmão Funari,
  • John C. Wood,
  • Andreza Alice Feitosa Ribeiro,
  • Nelson Hamerschlak

Journal volume & issue
Vol. 9, no. 2
pp. 165 – 172

Abstract

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Objectives: To evaluate the use of magnetic resonance imaging inpatients with β-thalassemia and to compare T2* magnetic resonanceimaging 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). Conclusion: 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.

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