Blood Res 2018; 53(4): 314-319  https://doi.org/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 
Hayder Al-Momen1, Shaymaa Kadhim Jasim2, Qays Ahmed Hassan3, Hayder Hussein Ali4
1Department of Pediatrics, Al-Kindy College of Medicine, University of Baghdad, 2Department of Obstetrics & Gynecology, College of Medicine, University of Baghdad, 3Division of Radiology, Department of Surgery, Al-Kindy College of Medicine, University of Baghdad, 4Department of Endocrinology, Al-Elwiya Pediatric Teaching Hospital, Al-Rusafa Health Directorate, Baghdad, Iraq
Correspondence to: Qays Ahmed Hassan, D.M.R.D., C.A.B.H.S(Rad), Division of Radiology, Department of Surgery, Al-Kindy College of Medicine, University of Baghdad, Al-Nahdha Squares, 10071 Baghdad, Iraq, E-mail: qtimeme@yahoo.com
Received: August 11, 2018; Revised: August 30, 2018; Accepted: August 30, 2018; Published online: December 31, 2018.
© The Korean Journal of Hematology. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0)which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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 (< 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.
Keywords: Thalassemia intermedia, Iron overload, Serum ferritin, R2-MRI


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