The use of MRI to monitor iron overload in SCD

Wood, John C.

doi:10.1016/j.bcmd.2017.09.002

Cited by 5 publications

(3 citation statements)

References 59 publications

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“…Measurements are often not routinely done. None of our long‐term multitransfused survivors had signs of beta‐cell dysfunction (i.e., normal fasting glucose and HbA1c; data not shown) in agreement with findings in sickle cell disease that pancreatic iron overload only occurred in patients with a LIC of >10 mg Fe/g .…”

Section: Discussionsupporting

confidence: 89%

Lifetime Transfusion Burden and Transfusion-Related Iron Overload in Adult Survivors of Solid Malignancies

et al. 2019

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Background Limited data exist on transfusion burden and transfusion‐related iron overload in adult survivors of solid malignancies. Methods Hospital‐specific cancer registry data of patients with solid tumor receiving systemic anticancer treatment between January 2008 and September 2009 at the Oncology Department of the Leiden University Medical Center (The Netherlands) were retrieved and cross‐referenced with red blood cell (RBC) transfusion records. Individual lifetime transfusion burden was captured in April 2015. Multitransfused long‐term survivors with serum ferritin >500 μg/L were subsequently screened for hepatic and cardiac iron overload using 1.5 Tesla magnetic resonance imaging. Results The study population consisted of 775 adult patients with solid cancer (45.2% male; median age, 58 years; >75% chemotherapy‐treated), 423 (54.6%) of whom were transfused with a median of 6.0 RBC units (range 1–67). Transfusion triggers were symptomatic anemia or hemoglobin <8.1–8.9 g/dL prior to each myelosuppressive chemotherapy cycle. We identified 123 (15.9%) patients across all tumor types with a lifetime transfusion burden of ≥10 RBC units. In the absence of a hemovigilance program, none of these multitransfused patients was screened for iron overload despite a median survival of 4.6 years. In 2015 at disclosure of transfusion burden, 26 multitransfused patients were alive. Six (23.1%) had hepatic iron overload: 3.9–11.2 mg Fe/g dry weight. No cardiac iron depositions were found. Conclusion Patients with solid malignancies are at risk for multitransfusion and iron overload even when adhering to restrictive RBC transfusion policies. With improved long‐term cancer survivorship, increased awareness of iatrogenic side effects of supportive therapy and development of evidence‐based guidelines are essential. Implications for Practice In the presence of a restrictive transfusion policy, ∼30% of transfused adult patients with solid cancer are multitransfused and ∼50% become long‐term survivors, underscoring the need for evidence‐based guidelines for the detection and management of transfusion‐related iron overload in this group of patients. In each institution, a hemovigilance program should be implemented that captures the lifetime cumulative transfusion burden in all patients with cancer, irrespective of tumor type. This instrument will allow timely assessment and treatment of iron overload in cancer survivors, thus preventing organ dysfunction and decreased quality of life.

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Section: Discussionsupporting

confidence: 89%

Lifetime Transfusion Burden and Transfusion-Related Iron Overload in Adult Survivors of Solid Malignancies

et al. 2019

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“…In this study, pancreatic R2* did not correlate with cardiac T2 * as all patients had normal cardiac T2*, and it had a nonlinear relationship with LIC. This data suggests that heavy hepatic siderosis is a prerequisite for cardiac and endocrine siderosis in SCD, unlike in TM [ 43 ], and that pancreas R2* values probably represent the most viable surrogate index for extrahepatic risk [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

The role of MRI-R2* in the detection of subclinical pancreatic iron loading among transfusion-dependent sickle cell disease patients and correlation with hepatic and cardiac iron loading

et al. 2022

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Objectives Pancreatic reserve could be preserved by early assessment of pancreatic iron overload among transfusion-dependent sickle cell disease (SCD) patients. This study aimed to measure pancreatic iron load and correlate its value with patients’ laboratory and radiological markers of iron overload. Materials and methods Sixty-six SCD children and young adults underwent MRI T2* relaxometry using a simple mathematical spreadsheet and laboratory assessment. Results The results indicated moderate-to-severe hepatic iron overload among 65.2% of studied cases. None had cardiac iron overload. Normal-to-mild iron overload was present in the pancreas in 86% of cases, and 50% had elevated serum ferritin > 2500 ug/L. There was no significant correlation between pancreatic R2* level, serum ferritin, and hepatic iron overload. Patients with higher levels of hemolysis markers and lower pre-transfusion hemoglobin levels showed moderate-to-severe pancreatic iron overload. Conclusion Chronically transfused patients with SCD have a high frequency of iron overload complications including pancreatic iron deposition, thereby necessitating proper monitoring of the body’s overall iron balance as well as detection of extrahepatic iron depositions.

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“…Transfusional iron overload may also lead to iron deposition in other tissues such as heart, liver and pancreas causing cellular toxicity and organ damage ( van Beers et al, 2015 , Wood, 2017 ). Therefore, identifying reliable and noninvasive biomarkers for iron overload is crucial.…”

Section: Iron In Scdmentioning

confidence: 99%

Ferroptosis as an emerging target in sickle cell disease

Fortuna,

Lima,

Oliveira

et al. 2024

Current Research in Toxicology

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The use of MRI to monitor iron overload in SCD

Cited by 5 publications

References 59 publications

Lifetime Transfusion Burden and Transfusion-Related Iron Overload in Adult Survivors of Solid Malignancies

Lifetime Transfusion Burden and Transfusion-Related Iron Overload in Adult Survivors of Solid Malignancies

The role of MRI-R2* in the detection of subclinical pancreatic iron loading among transfusion-dependent sickle cell disease patients and correlation with hepatic and cardiac iron loading

Ferroptosis as an emerging target in sickle cell disease

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