Thalassemia Major: Who Is Afraid of Serum Ferritin below 500 μg/l?

Pinna, Francesca; Carta, Roberto; Morittu, Maddalena; Dessì, Carlo; Moi, Paolo; Leoni, G; Foschini, Maria Loreta; Defraia, Elisabetta; Zappu, Antonietta; Origa, Raffaella

doi:10.1159/000371866

Cited by 3 publications

(1 citation statement)

References 5 publications

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“…Kolnagou et al, using the same protocol to reach normal iron depots, showed that normal ferritin levels could be maintained using deferiprone monotherapy without serious toxicity and symptoms of overchelation [38]. More recently, a report from Pinna et al described the clinical management of patients with thalassemia major who reached serum ferritin values < 500 ng/mL in the last 15 years [39]. In this retrospective evaluation, patients under DFX or DFX plus DFO combination were also described, but a general tolerability and side effects that were not significant in patients who stayed under 500 ng/mL were reported, apart from the description of rachiodynia whose appearance was not judged as definitely related to iron depletion by the authors.…”

Section: Discussionmentioning

confidence: 99%

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

Spasiano

Meloni

Costantini

et al. 2021

JCM

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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.

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Section: Discussionmentioning

confidence: 99%