Serum ferritin iron in iron overload and liver damage: Correlation to body iron stores and diagnostic relevance

2000 ◽  
Vol 135 (5) ◽  
pp. 413-418 ◽  
Author(s):  
Peter Nielsen ◽  
Ulrike Günther ◽  
Matthias Dürken ◽  
Roland Fischer ◽  
Jochen Düllmann
Keyword(s):  
Iron Overload ◽  
Serum Ferritin ◽  
Liver Damage ◽  
Body Iron ◽  
Iron Stores ◽  
Ferritin Iron

scholarly journals Serum Ferritin Iron, a New Test, Measures Human Body Iron Stores Unconfounded by Inflammation

Stem Cells ◽  
1997 ◽  
Vol 15 (4) ◽  
pp. 291-296 ◽  
Author(s):  
Victor Herbert ◽  
Elizabeth Jayatilleke ◽  
Spencer Shaw ◽  
Alan S. Rosman ◽  
Patricia Giardina ◽  
...  
Keyword(s):  
Serum Ferritin ◽  
Human Body ◽  
Body Iron ◽  
Iron Stores ◽  
Ferritin Iron

Inadequate Long-Term Control Of Transfusion Iron Overload In Children With Sickle Cell Disease Chelated With Deferasirox

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 998-998
Author(s):  
Eva Tsouana ◽  
Banu Kaya ◽  
Nimze Gadong ◽  
Claire Hemmaway ◽  
Heather Newell ◽  
...  
Keyword(s):  
Iron Overload ◽  
Serum Ferritin ◽  
Extension Study ◽  
Effective Control ◽  
Efficacy And Safety ◽  
Normal Range ◽  
Body Iron ◽  
Iron Stores ◽  
The Mean

Abstract Background and objectives Evidence-based indications for regular transfusions in children with SCD are increasing, and there is now a large population of children on long-term transfusion who require effective control of iron stores to prevent toxicity from transfusion iron overload. The oral iron chelating agent deferasirox (DFX) has been evaluated extensively in thalassemia major, but long-term data on efficacy and safety in children with SCD is relatively sparse. A Phase II trial by Vichinsky et al (2006) compared DFX with deferrioxamine (DFO) in 185 patients (50% paediatric) over one year. The extension study up to 5 years indicated a gradual improvement in serum ferritin associated with increased dose reaching a mean of 25 mg/kg/day. Responses were noted to be poorer in children. The extension study included only 33.5% of the original cohort and is not representative of the full population of children with SCD requiring long-term chelation. Furthermore, the study did not include sequential monitoring of liver iron concentration (LIC), which is considered a better measure of body iron and of chelation efficacy in SCD. In this study, we have evaluated the long-term efficacy and safety of DFX in a clinical care setting and addressed some of the deficiencies of the above study. Methods This was a multicentre retrospective, observational study of regularly transfused children in the East London and Essex Clinical Haemoglobinopathy Network. A standard protocol for dosing and monitoring was initiated after licensing of DFX in the EU in 2006. Initial dose was 20mg/kg, and increased in increments of 5mg/kg up to 35 mg/kg/day. Dose was interrupted for creatinine above the normal range for age, or for ALT elevations over 2 times the upper limit of normal when other aetiologies had been excluded. Monitoring of body iron was with monthly serum ferritin (SF) and annual R2 MRI-estimated LIC (in children aged >8 years). Adherence was assessed at monthly transfusion episodes. Support and encouragement with adherence to therapy was provided by dedicated nurse specialists in the hospital and community and a clinical psychologist. Adherence and acceptability were assessed by a questionnaire adapted from Alvarez et al (2009). For this study, data was censored at 36 months from treatment initiation. Results Sixty-two patients were included, the mean age at initiation of DFX was 9.2 years and mean chelation duration 2.5 ±1.4 years. There were 120.7 years of patient exposure up to 36 months of treatment. The initial mean (± SD) daily dose was 19.8 ± 3.1 mg/kg and at 36 months was 24.6 ± 9.7 mg/kg. Mean SF increased significantly from 2542 ± 964ng/ml at baseline to 4691 ± 2255ng/ml at 36 months; the mean change was 1548ng/ml (95% confidence intervals; -26, 3122ng/ml, p=0.053). There was no significant change in LIC from first to second MRI scan (mean 10.3 mg/g dw on initial and 11.4 mg/g dw on second scan, p=0.35). We observed a statistically significant correlation (R2 =0.66, p <0.001) between the relative change in LIC and in SF. Serum creatinine and estimated Glomerular Filtration Rate (Schwartz formula) remained stable and within normal range. Fifty-two episodes of ALT elevation were recorded in 33 patients, with 14 having recurrent episodes (mean number of episodes per year 2.1± 0.8). In the questionnaire responses, adherence for at least 80% of doses was reported by 75% of respondents. However, more than 50% indicated problems when taking DFX, the most frequent complaint being unpleasant taste. Conclusions Our experience in a large cohort of children with SCD indicate that iron stores, assessed by combined modalities of SF and LIC, are not adequately controlled with current recommended dosing regimes for DFX. This may be due to inadequate adherence, less favorable pharmacokinetics in children compared to adults, frequent elevations of ALT necessitating interruptions of dosing, or insufficient efficacy of DFX in this population. Changes in SF appear to have a useful role in assessing efficacy and show a reasonable correlation with changes in LIC. Alternative dosing regimes, combinations with other chelators, and more use of exchange transfusion in children may be needed to optimize iron stores in chronically transfused children with SCD. Studies that include a larger number of children and longer follow up periods are required in order to further validate these observations, and explore the role of alternative management strategies. Disclosures: No relevant conflicts of interest to declare.

Risk of Iron Overload among Middle-aged Women

2000 ◽  
Vol 70 (3) ◽  
pp. 119-125 ◽  
Author(s):  
Ikuko Kato ◽  
Ann Dnistrian ◽  
Morton Schwartz ◽  
Paolo Toniolo ◽  
Karen Koenig ◽  
...  
Keyword(s):  
Iron Overload ◽  
Serum Ferritin ◽  
Menopausal Status ◽  
Dietary Factors ◽  
Potential Hazard ◽  
Middle Aged ◽  
Ferritin Concentration ◽  
Body Iron ◽  
Iron Stores ◽  
The Mean

Iron overload, expressed as increased body iron stores, has been recognized as a potential hazard because it promotes the generation of oxygen radicals. We analyzed factors associated with serum ferritin levels (an indicator of body iron stores) among middle-aged women with a high prevalence of nutrient supplement use. Serum ferritin concentrations were determined on automated immunoassay for 487 healthy women with the mean age of 57 years who participated in the New York University Women’s Health Study. The mean serum ferritin concentration in postmenopausal women was more than twice that in premenopausal women. Serum ferritin concentrations progressively increased with advancing age, but adjustment for menopausal status considerably weakened this association. Among non-dietary factors, nonwhite ethnicity, obesity and cigarette smoking were positively associated with serum ferritin concentrations. After adjustment for these factors and for menopausal status, serum ferritin levels were positively associated with meat intake and multivitamin use and inversely associated with breakfast cereal consumption. However, none of these lifestyle factors positively associated with serum ferritin levels had a significant impact on serum ferritin levels above 100 ng/ml (dissimilar median concentration). Our results suggest that iron overload seems unlikely among middle aged women through their diet and nutritional supplements.

scholarly journals Reduction of tissue iron stores and normalization of serum ferritin during treatment with the oral iron chelator L1 in thalassemia intermedia

Blood ◽  
1992 ◽  
Vol 79 (10) ◽  
pp. 2741-2748 ◽  
Author(s):  
NF Olivieri ◽  
G Koren ◽  
D Matsui ◽  
PP Liu ◽  
L Blendis ◽  
...  
Keyword(s):  
Iron Overload ◽  
Serum Ferritin ◽  
Iron Concentration ◽  
Transferrin Saturation ◽  
Dramatic Improvement ◽  
Thalassemia Intermedia ◽  
Ferritin Concentration ◽  
Iron Stores ◽  
Tissue Iron ◽  
Serum Ferritin Concentration

Abstract In patients with thalassemia intermedia in whom hyperabsorption of iron may result in serious organ dysfunction, an orally effective iron- chelating drug would have major therapeutic advantages, especially for the many patients with thalassemia intermedia in the Third World. We report reduction in tissue iron stores and normalization of serum ferritin concentration after 9-month therapy with the oral chelator 1,2- dimethyl-3-hydroxypyrid-4-one (L1) in a 29-year-old man with thalassemia intermedia and clinically significant iron overload (SF 2,174 micrograms/L, transferrin saturation 100%; elevated AST and ALT, abnormal cardiac radionuclide angiogram) who was enrolled in the study with L1 75 mg/kg/day after he refused deferoxamine therapy. L1-Induced 24-hour urinary iron excretion during the first 6 months of therapy was (mean +/- SD, range) 53 +/- 30 (11 to 109) mg (0.77 mg/kg), declining during the last 3 months of L1 to 24 +/- 14 (13–40) mg (0.36 mg/kg), as serum ferritin decreased steadily to normal range (present value, 251 micrograms/L). Dramatic improvement in signal intensity of the liver and mild improvement in that of the heart was shown by comparison of T1- weighted spin echo magnetic resonance imaging with images obtained immediately before L1 administration was observed after 9 months of L1 therapy. Hepatic iron concentration decreased from 14.6 mg/g dry weight of liver before L1 therapy to 1.9 mg/g liver after 9 months of therapy. This constitutes the first report of normalization of serum ferritin concentration in parallel with demonstrated reduction in tissue iron stores as a result of treatment with L1. Use of L1 as a therapeutic option in patients with thalassemia intermedia and iron overload appears warranted.

Relationship between serum ferritin, iron stores and disease activity in rheumatoid arthritis

1986 ◽  
Vol 16 (3) ◽  
pp. 463-469
Author(s):  
Carlo Palermo ◽  
Susanna Maddali Bongi ◽  
Gianfranco Bianucci
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Serum Ferritin ◽  
Iron Stores ◽  
Ferritin Iron

Phlebotomy as an Effective Treatment for Iron Overload after Allogeneic Hematopoietic Cell Transplantation: Iron Depletion Kinetics Are Influenced by the Donor Hemochromatosis (HFE) Genotype.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3717-3717
Author(s):  
Ann-Kathrin Eisfeld ◽  
Medical Student ◽  
Ralph Burkhardt ◽  
Sabine Schroeder ◽  
Rainer Krahl ◽  
...  
Keyword(s):  
Liver Function ◽  
Iron Overload ◽  
Cell Transplantation ◽  
Serum Ferritin ◽  
Hematopoietic Cell Transplantation ◽  
Hematopoietic Cell ◽  
Hfe Gene ◽  
Blood Transfusions ◽  
Iron Depletion ◽  
Iron Stores

Abstract Introduction: Iron metabolism plays an important role in hematopoiesis and immune response. In the present project, body iron stores and factors affecting iron storage such as HFE genotype and the number of blood transfusions were evaluated in patients after allogeneic hematopoietic cell transplantation (HCT). In patients with iron overload, the effect of phlebotomy (PT) on iron stores was analysed in correlation to HFE mutations. Patients and methods: Serum ferritin was measured in 201 consecutive patients transplanted from January 2001 to December 2004 at the University of Leipzig. After excluding patients with normal body iron (serum ferritin levels between 30–400 ng/ml) and patients surviving less than 4 months after HCT, 61 patients (31 males/30 females; median age 48 y) treated with PT were evaluated. Diagnoses included acute leukemias (n=29; 48%), chronic leukemias (n=15; 24%), MDS (n=8; 13%) and others (n=9; 15%). 33 patients (54%) were conditioned with Cyclophosphamid 120 mg/kg and 12 Gy TBI. Patients with unrelated donors received ATG 15 mg/kg/day for 3 days. The remaining patients (n=28; 46%) were treated with Fludarabin 30 mg/m2/day for 3 days and TBI 2 Gy applied once. Donors were matched related in 21 (34%) and matched unrelated in 40 (66%) patients. HFE genotype of patients and donors were analysed by real time PCR using a LightCycler, Roche. The effectiveness of PT was assessed by serum ferritin and liver function test evaluation. Results: The majority of patients after HCT (n=172; 86%) had iron overload with a median ferritin of 1697 ng/ml. From these, 61 patients received PT. These patients received a median of 28 (range 2–102) units of blood transfusions. Acute GvHD ≥ grade II was present in 25 (41%) and chronic GvHD in 19 (31%) patients. Elevated SGPT/SGOT and AP were detected in 34 (56%) and 39 (64%) patients respectively. Mutations in the HFE gene were found in 14 (25%) prior to HCT: heterozygosity (het) for H63D (n=10), for C282Y (n=3) and homozygosity for H63D (n=1). Similarly, 22 donors (40%) showed het. for H63D (n=12), for C282Y (n=4) and for S65C (n=4). Two donors were homozygous for S65C. After HCT, all pts expressed donor HFE genotype. PT was performed every 2 weeks with a median of 200 ml blood removed in one session. Interestingly, median Hemoglobin (Hb) rose under PT (p&lt;0.0001). PT resulted in a significant depletion of iron stores (p&lt;0.0001), improvement in SGPT/SGOT (p=0.002), bilirubin (p&lt;0.0001), and AP (p=0.01). In multivariate analysis, a slower rate of iron depletion significantly correlated with mutated donor HFE genotype (p=0.002). In such patients less iron/ml blood were removed per PT and more often PT were required compared to patients with wildtype HFE donors. Conclusions: Iron overload is a frequent complication after HCT. PT is highly effective in removing excess iron and improving Hb and liver function associated with iron overload after HCT. Patients transplanted from a donor with a mutant HFE gene showed slower iron depletion kinetics by PT compared to patients transplanted from donors with wildtype HFE. The role of donor HFE genotype is currently being analysed in patients after HCT.

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