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

Hayder Al-Momen; Shaymaa Kadhim Jasim; Qays Ahmed Hassan; Hayder Hussein Ali

doi:10.5045/br.2018.53.4.314

Quick links

Most Cited Most Read Ahead of Print Archives Go to E-submission

Original Article

Split Viewer

Blood Res 2018; 53(4):

Published online December 31, 2018

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, and Hayder Hussein Ali⁴

Author Info. +

¹Department of Pediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq.

²Department of Obstetrics & Gynecology, College of Medicine, University of Baghdad, Baghdad, Iraq.

³Division of Radiology, Department of Surgery, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq.

⁴Department of Endocrinology, Al-Elwiya Pediatric Teaching Hospital, Al-Rusafa Health Directorate, Baghdad, Iraq.

Correspondence to : 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. qtimeme@yahoo.com

Received: August 11, 2018; Revised: August 30, 2018; Accepted: August 30, 2018

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

Go to

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.

Keywords Thalassemia intermedia, Iron overload, Serum ferritin, R2-MRI

Article

Original Article

Blood Res 2018; 53(4): 314-319

Published online December 31, 2018 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, and Hayder Hussein Ali⁴

¹Department of Pediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq.

²Department of Obstetrics & Gynecology, College of Medicine, University of Baghdad, Baghdad, Iraq.

³Division of Radiology, Department of Surgery, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq.

⁴Department of Endocrinology, Al-Elwiya Pediatric Teaching Hospital, Al-Rusafa Health Directorate, Baghdad, Iraq.

Correspondence to: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. qtimeme@yahoo.com

Received: August 11, 2018; Revised: August 30, 2018; Accepted: August 30, 2018

Abstract

Background

Methods

Results

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

Abstract

Fig 1.

Download

Figure 1.

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

Blood Research 2018; 53: 314-319https://doi.org/10.5045/br.2018.53.4.314

Fig 2.

Download

Figure 2.

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

Blood Research 2018; 53: 314-319https://doi.org/10.5045/br.2018.53.4.314

Fig 3.

Download

Figure 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.

Blood Research 2018; 53: 314-319https://doi.org/10.5045/br.2018.53.4.314

Fig 4.

Download

Figure 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.

Blood Research 2018; 53: 314-319https://doi.org/10.5045/br.2018.53.4.314

Fig 5.

Download

Figure 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.

Blood Research 2018; 53: 314-319https://doi.org/10.5045/br.2018.53.4.314

Fig 6.

Download

Figure 6.

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

Blood Research 2018; 53: 314-319https://doi.org/10.5045/br.2018.53.4.314

Fig 7.

Download

Figure 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.

Blood Research 2018; 53: 314-319https://doi.org/10.5045/br.2018.53.4.314

Table 1 . General patient data..

Continuous variables expressed as mean±SD. ^a)Student t-test. ^b)Chi-square test..

Abbreviations: Hb, hemoglobin; LIC, liver iron concentration; SD, standard deviation; SF, serum ferritin; TI, thalassemia intermedia; TM, thalassemia major..