Blood Res.  2018 Dec;53(4):314-319. 10.5045/br.2018.53.4.314.

Relationship between liver iron concentration determined by R2-MRI, serum ferritin, and liver enzymes in patients with thalassemia intermedia

• Al-Momen H
• Jasim SK
• Hassan QA
• Ali HH

• KMID: 2429306
• DOI: http://doi.org/10.5045/br.2018.53.4.314

Abstract

BACKGROUND
Iron overload is a risk factor affecting all patients with thalassemia intermedia (TI). We aimed to determine whether there is a relationship of serum ferritin (SF) and alanine aminotransferase (ALT) with liver iron concentration (LIC) determined by R2 magnetic resonance imaging (R2-MRI), to estimate the most relevant degree of iron overload and best time to chelate in patients with TI.
METHODS
In this cross-sectional study, 119 patients with TI (mean age years) were randomly selected and compared with 120 patients who had a diagnosis of thalassemia major (TM). Correlations of LIC, as determined by R2-MRI, with SF and ALT levels, were assessed in all participants. A P-value < 0.05 was considered statistically significant.
RESULTS
SF and LIC levels were lower in patients with TI than in those with TM; only ferritin values were significant. We found a statistically significant relationship between SF and LIC, with cut-off estimates of SF in patients with TI who had splenectomy and those who entered puberty spontaneously (916 and 940 ng/mL, respectively) with LIC >5 mg Fe/g dry weight (P < 0.0001). A significant relationship was also found for patients with TI who had elevated ALT level (63.5 U/L), of 3.15 times the upper normal laboratory limit, using a cut-off for LIC ≥5 mg Fe/g dry weight.
CONCLUSION
We determined the cut-off values for ALT and SF indicating the best time to start iron chelation therapy in patients with TI, and found significant correlations among iron overload, SF, and ALT.

Keyword

Thalassemia intermedia; Iron overload; Serum ferritin; R2-MRI

MeSH Terms

Adolescent
Alanine Transaminase
beta-Thalassemia*
Chelation Therapy
Cross-Sectional Studies
Diagnosis
Ferritins*
Humans
Iron Overload
Iron*
Liver*
Magnetic Resonance Imaging
Puberty
Risk Factors
Splenectomy
Thalassemia*
Alanine Transaminase
Ferritins
Iron

Figure

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  Fig. 1 Correlation between serum ferritin and liver iron concentration as determined by R2-MRI in patients with thalassemia intermedia and thalassemia major.

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  Fig. 2 Relationship between serum ferritin and liver iron concentration as determined by R2-MRI in patients with thalassemia intermedia who have undergone splenectomy.

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  Fig. 3 ROC curve for the correlation between serum ferritin and liver iron concentration >5 mg Fe/g dry weight in patients with thalassemia intermedia who have undergone splenectomy.

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  Fig. 4 Relationship between serum ferritin and liver iron concentration as determined by R2-MRI in patients with thalassemia intermedia who had spontaneous onset of puberty.

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  Fig. 5 ROC curve of the correlation between serum ferritin and liver iron concentration >5 mg Fe/g dry weight in patients with thalassemia intermedia who had spontaneous puberty with no delay.

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  Fig. 6 Relationship between alanine aminotransferase (ALT) and liver iron concentration as determined by R2-MRI in patients with thalassemia intermedia.

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  Fig. 7 ROC curve of the correlation between alanine aminotransferase (ALT) and liver iron concentration >5 mg Fe/g dry weight in patients with thalassemia intermedia.

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