López-Hernández MA, Alvarez VJL

Language: Spanish
References: 22
Page: 17-22
PDF size: 400.98 Kb.

ABSTRACT

Background: Haematological conditions associated with acquired hemosiderosis include hemolysis, ineffective erythropoiesis, neoplasms and those secondary to multiple transfusions. Its treatment is necessary and generally contemplated only in extreme cases. The real incidence of those who quelantes require, is not known.
Objective:To identify the frequency of iron overload, by means of serum ferritin, in patients majors of 15 years, with hemopathies, taken care of in the Servicio de Hematología del Centro Médico Nacional “20 de Noviembre”.
Patients and methods: Cross-sectional, non-randomized, single centre, prospective and descriptive study. Older than 15 years, with some condition that required transfusion of more than three units of red blood cell. Excluded: hemochromatosis, paroxysmal nocturnal hemoglobinuria, anaemia ferropriva, sepsis and leukemia with neoplastic activity. Serum ferritin was determined (immunoassay). Other studied variables: time of evolution, treatment, number of transfusions, transaminases, alkaline phosphatase, lactic dehydrogenase and creatinine.
Results: 54 patients were included. Basic disease: acute leukemias (n = 32), myelodisplástic syndromes (n = 10), multiple myeloma (n = 8) and chronic leukaemia (n = 4). Transfused units averaged 12 (4-43). Receiving intensive chemotherapy 28 and immunosuppression 8. Average of ferritin 1 ' 143 ng/mL (107 ng/mL - 3810 ng/mL). It was greater of 1 ' 000 ng/mL in 54% of patients. In the multivariate regression there was relation with the amount of transfusions (p= 0.0001) and elevation of transaminases (p = 0.003). The elevation of these was only related with the ferritin.
Conclusion: More than half of patients had levels of ferritin requiring quelant agents. In patients with acute leukemia elevation of transaminases is associated with hiperferritinemia.

REFERENCES

1. Torti FM. Regulation of ferritin genes and protein. Blood 2002;99:3505-3515.

2. Vives Corrons JL, Altes A. Anemia ferropénica y trastornos del metabolismo del hierro. Hematología clínica. 5a ed. Madrid: Elsevier, 2006; p:125-161.

3. Gelvan C, Fibach E. Ferritin uptake by human erythroid precursors is a regulated iron uptake pathway. Blood 1996;88:3200-3207.

4. Cazzola M, Deza L, Bergamaschi G, Barosi G, Bellotti V. Biologic and clinical significance of red cell ferritin. Blood 1983;62:1078-1087.

5. Sharmistha G. Regulated secretion of glycosylated human ferritin from hepatocytes. Blood 2004;103:2369-2376.

6. Brittemham GM, Badman DG. Noninvasive measurement of iron: report of an NIDDK workshop. Blood 2003;101:15-19.

7. Altes A, Remacha AF, Sureda A, Martino R, et al. Patients with biochemical iron overload: causes and characteristics of a cohort of 150 cases. Annals of Hematology 2003;82:127-130.

8. Wood JC, Origa R, Agus A, Matta G, et al. Onset of cardiac iron loading in pediatric patients with thalasemia major. Haematologica 2008;93:917-920.

9. Ronald JE, Sheldon M. Effect of induced fever on serum iron and ferritin concentrations in man. Blood 1977;49:147-153.

10. Porter JB. Practical management of iron overload. Br J Haematol 2001; 115:239-252.

11. Olivieri NF, Brittenham GM. Iron-chelating therapy and the treatment of thalassemia. Blood 1997;89:739-761.

12. Timothy B. Iron Chelators for the Treatment of Iron Overload Disease: Relationship Between Structure, Redox Activity, and Toxicity. American Journal of Hematology 2003;73:200-210.

13. Mourad FH, Hoffbrand AV, Sheikh-Taha M, Koussa S, et al. Comparison between desferrioxamine and combined therapy with desferrioxamine and deferiprone in iron overloaded thalassaemia patients. Br J Haematol 2003;121(1):187-189.

14. Glickstein H, et al. Intracellular labile iron pools as direct targets of iron chelators: a fluorescence study of chelator action in living cells. Blood 2005; 106:3242-3250.

15. Hoffbrand AV. Recent advances in the understanding of iron metabolism and iron-related diseases. Acta Haematol 2009;122(2-3):75-77.

16. Norma Oficial Mexicana NOM-003-SSA2-1993 “Para la disposición de sangre humana y sus componentes con fines terapéuticos”.

17. Waalen J, Felitti V. Screening for hemochromatosis by measuring ferritin levels: a more effective approach. Blood 2008;111:3373-3377.

18. Armand P, Haesook T, Kim HT, Cutler CS, et al. Prognostic impact of elevated pretransplant serum ferritin in patients undergoing myeloablative stem cell transplatation. Blood 2007;109;4586-4588.

19. Wick M, Pinggera W, Lehman P. Clinical aspects and laboratory iron metabolism, anemias. New York: Springer, 2003;p:27.

20. Jensen PD, Finn T, Thorkil C, Nielsen JL, Ellegaard J. Relation between hepatocellular injury and transfusional iron overload prior to and during iron chelation with desferrioxamine: a study in adult patients with acquired anemias. Blood 2003;101:91-96.

21. Pullarkat V, Blanchard S, Tegtmeier B, Patane K, et al. Iron overload adversely affects outcome of allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2008;42:799-805.

22. Jabbour E, Kantarjian H, Koller C, Taher A. Red Blood Cell Transfusions and Iron Overload in the Treatment of Patients with Myelodysplastic Syndromes. Cancer 2008;112:1089-1095.