FORMATION OF IRON EXCESS IN PATIENTS WITH INTERMEDIATE- AND LOWER-RISK MYELODYSPLASTIC SYNDROME

Abstract

The aim of study was to determine main types of iron overload in the intermediate- and lower-risk patients with myelodysplastic syndrome by using the research data of clinical and biochemical features of iron metabolism. Material and methods. A total of 22 patients with myelodysplastic syndrome, treated in Novosibirsk Hematological Centre, were examined. The average age was 62.6 ± 12.2 years. Among them, 14 (63.6 %) patients were transfusion-dependent and 8 (36.4 %) patients without transfusion dependence. To analyze the iron metabolism, the standard measures of iron status (serum iron and ferritin content, total and latent iron binding capacity, transferrin saturation) as well as additional markers, measured by ELISA (serum hepcidin content) were used. Results and discussion. The role of multiple transfusions in formation of iron excess in patients with myelodysplastic syndrome was demonstrated. In the transfusion-dependent group of patients the serum iron was 31.56 ± 15.59 μmol/l, transferrin saturation level – 64.1 ± 32.92 %, total and latent iron binding capacity – 48.87 ± 11.7 and 17.32 ± 12.66 μmol/l, serum ferritin level – 689.08 ± 104.98 ng/ml (in non-transfusion dependent group – 24.6 ± 7.58 μmol/l, 31.28 ± 19.48 %, 51.6 ± 17.41 and 35.86 ± 16.98 μmol/l, respectively). The trends in associated changes of ferritin and hepcidin level depending on the number of obtained transfusions showed the following results: less than 9 transfusions – r = 0.96 (n = 6; p < 0.001), from 9 to 24 erythrocyte units – r = 0.009 (n = 9; p > 0.06), more than 24 transfusions per year – r = –0.55 (n = 7; p < 0.05). It proved the loss of sensitivity of hepcidin level to ferritin level in patients with high transfusion burden. Conclusion. The study demonstrated the role of ineffective hematopoiesis in the regulation disorders of hepcidin level in patients with myelodysplastic syndrome and iron overload formation without connection with transfusions.

Keywords

• myelodysplastic syndrome
• ineffective hematopoiesis
• hepcidin
• ferritin
• transfusion dependence
• ferrokynetics
• iron metabolism
• iron excess