Erythrocyte Ferritin in Patients with Chronic Renal Failure and Heterozygous Beta-Thalassemia

Abstract

Aim: The aim of this research is to study the variance of erythrocyte ferritin (EF) in patients with chronic renal failure (CRF) and heterozygous β-thalassemia (β-TA), as well as the use of EF as a more reliable index for assessing the body iron status. Methods: We studied 63 subjects with CRF, 40 subjects with heterozygous β-TA, 53 subjects with CRF and heterozygous β-TA and 24 normal subjects. In 11 patients with CRF and heterozygous β-TA, sternal bone marrow aspiration was performed to evaluate iron stores in the bone marrow. EF was determined in the hemolysate of washed erythrocytes by a radioimmunoassay. Results: EF showed the strongest correlation with bone marrow iron (p < 0.001) in comparison with the remaining hematological parameters that were examined. Patients with CRF without heterozygous β-TA showed an increase in serum ferritin (SF), even in cases of iron deficiency. In the group of heterozygous β-TA without renal failure, 22.5% of patients showed an increased EF content up to 150 ag/cell and a tendency for iron overload. Patients with CRF and heterozygous β-TA showed a high value of EF, up to 200 ag/cell, and iron overload in 22.6%, almost the same proportion as in the previous group. It was also observed that a high value of SF does not indicate iron overload for these patients. In the group of hemodialysis, patients without heterozygous β-TA who were under erythropoietin (EPO) treatment presented iron deficiency. Many patients with CRF and heterozygous β-TA who were taking EPO presented iron overload, while very few of them presented iron deficiency. Conclusion: These findings suggest that EF is a reliable index for assessing the iron status in patients with CRF and heterozygous β-TA.

Serum ferritin is an important inflammatory disease marker, as it is mainly a leakage product from damaged cells

“…Thus, importantly, ferritin is made in cells (including intestinal cells), and not in serum. We also note the evidence for the presence of ferritin within erythrocytes, [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] the largest volume fraction of serum. 55 In nucleated cells, ferritin resides mainly in the cytoplasm, but there are nuclear [56][57][58][59][60][61] and mitochondrial [62][63][64] forms (not considered here, as our focus is serum ferritin).…”

“…440,441 Correlation of platelet microparticles with serum ferritinfurther evidence for the cell damage hypothesis As mentioned, a considerable number of papers note the presence of ferritin in erythrocytes, the largest cellular compartment in blood. 40,[43][44][45][46][47][48][49][50]53,54 In RBCs, one of the more notable cell death mechanisms is eryptosis, a suicidal death of erythrocytes; this is characterized by erythrocyte shrinkage, blebbing, and phospholipid scrambling of the cell membrane. There is limited evidence that eryptosis occurs in iron overload conditions like b-thalassemia.…”