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

Abstract

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.

The association between plasma IL-6 levels and several thalassemia-related clinical features in Iraqi patients

“…The results indicated that serum levels of ferritin were extremely high in both TM and TI groups, which indicates that iron overload can cause serious health issues in thalassemia patients if left untreated. Iron overload may be a result of blood transfusion and ineffective extramedullary erythropoiesis [35,36].Howover,ferritin elevation may reflect conditions unrelated to iron metabolisms, such as inflammation, liver injury, and steatohepatitis [37].Consistent with our finding, a previous study suggested that IL-6 may increase ferritin synthesis. Also, both ferritin and IL-6 have a significant correlation to affect serum adiponectin, CRP, Hb concentration, and platelet count [38].…”

Glucose Homeostasis and Αssessment of Β-Cell Function by 3-Hour Oral Glucose Tolerance (Ogtt) in Patients With Β-Thalassemia Major With Serum Ferritin Below 1,000 Ng/Dl: Results From a Single Icet-a Centre

“…No difference was found in the frequency of hypogonadism, hypothyroidism, hypoparathyroidism, osteopenia/osteoporosis, arrhythmias, and hepatic cirrhosis among the 3 groups. 7 Chelation therapy was started at the mean age of 7.3 ± 5.1 years; 5.8± 4.3 years; and 6.2 ± 6.7 years, respectively. The difference was not statistically significant between groups of patients (P: 0.25).…”

“…Diabetes mellitus was detected in 15.6%, 7% and 10.7%, respectively (P: 0.487). 7 No information was reported about other abnormalities of glucose homeostasis. MRI pancreatic IOL was comparable among the three groups.…”

“…No signs of hematological/renal toxicity were documented in any of these patients. 7 The primary aim of this study was to evaluate in depth the variations of glucose homeostasis and surrogates indices of insulin sensitivity and resistance, during a 3hour OGTT, in adult β-TM patients with SF below 1,000 ng/mL.…”

Special Issue: “Emerging Therapies and Strategies in Thalassemia: Toward a New Era in Management”

“…These studies evaluated two opposite conditions. The first article by Ricchi et al reported a cross-sectional study and focuses on the feasibility of achieving serum ferritin < 500 ng/mL for several TDT patients under different chelation regimens [ 1 ]. Such a ferritin target, at MRI T2* evaluation, was associated with the absence of significant cardiac and hepatic iron overload (IO) but with a noteworthy proportion of patients showing simultaneous pancreatic IO.…”