A study of serum ferritin, alanine transaminase and hepatic MRI T2* values in β-thalassemia major patients

Authors

  • Shikha Jain Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Indore, Madhya Pradesh
  • Nirbhay Mehta Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Indore, Madhya Pradesh
  • Sharad Thora Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Indore, Madhya Pradesh

DOI:

https://doi.org/10.18203/2349-3291.ijcp20163679

Keywords:

β-thalassemia major, Hepatic MRI T2*

Abstract

Background:Present transfusion protocols have increased life expectancy of patients with β-thalassemia. Non-invasive T2* MRI is a newer technique in developing countries with promising role in management of thalassemia. Our goal was to assess the hepatic dysfunction in multi-transfused thalassemia patients by estimating iron overload using hepatic MRI T2* values, and correlating the results with serum ferritin and serum alanine transaminase (ALT) values.

Methods: This was a cross-sectional study of regularly transfused thalassaemia major patients from Thalassemia Center of Chacha Nehru Bal Chikitsalaya, M. Y. Hospital, a referral thalassaemia centre in Indore, Madhya Pradesh, India. The study was approved by the ethics committee of MGM Medical College, Indore, India. The study was conducted between August 2011 and September 2012. β-thalassaemia major patients who were regularly transfused and between the age of 5 to 15 years, were included.

Results: It was found that thirty three percent of the patients had hepatic MRI T2* values less than 6.3ms. Serum ALT levels were found to be above three times the normal range in 88% of patients. Significant liver iron deposition starts occurring at an early age leading to liver dysfunction. Serum ferritin levels did not linearly correlate with liver iron load thus it may not be a reliable marker for monitoring of chelation therapy.

Conclusions:For better management of thalassaemia patients, hepatic MRI T2* is suggested, instead of relying solely on serum ferritin.  

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References

Giardina PJ. Thalassemia syndromes. In: Hoffman R, Benz EJ, Shattil SS. Hematology: Basic Principles and Practice. 5th edition. Philadelphia, USA: Elsevier Churchill Livingstone; 2008.

Debaun MR, Jones MJ, Vichinsky EP. Thalassemia Syndromes. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF,editors. Nelson: Textbook of Pediatrics. First south Asia Edition. Reed Elsevier India private limited; India. 2016:2349.

Gabutti V, Piga A, Sacchetti L. Quality of life and life expectancy in thalassemic patients with complications. Prog Clin Biol Res. 1989;309:35-41.

Guidelines for the clinical management of Thalassaemia (updated 2nd edition). Thalassaemia International Federation (TIF). 2008.

Argyropoulou MI, Astrakas L. MRI evaluation of tissue iron burden in patients with beta-thalassaemia major. Pediatric Radiology. 2007;37:1308-9.

Angelucci E, Brittenham GM, McLaren CE. Hepatic iron concentration and total body iron stores in thalassemia major. New England J Med. 2000;343(5):327-31.

Brittenham GM, Cohen AR, Mclaren CE. Hepatic iron stores and plasma ferritin concentration in patients with sickle cell anemia and thalassemia major. Am J Hematol. 1993;42(1):81-5.

Pierre TG. Noninvasive measurement and imaging of liver iron concentrations using proton magnetic resonance. Blood. 2005;105:855-61.

Zamani F. T2* magnetic resonance imaging of the liver in thalassemic patients in Iran. World J Gastroenterol. 2011;17:522-5.

Wu X, Jing Y, Pei F, Chen J, Feng X, He Y, Zhang Y, Li C. Value of magnetic resonance imaging T2* tests in detecting heart and liver iron overload in patients with β-thalassemia major. Nan Fang Yi Ke Da Xue Xue Bao. 2013;33(2):249-52.

Eghbali A, Taherahmadi H, Shahbazi M, Bagheri B, Ebrahimi L. Association between serum ferritin level, cardiac and hepatic T2-star MRI in patients with major β-thalassemia. Iran J Ped Hematol Oncol. 2014;4(1):17-21.

Mazza P, Giua R, Marco S, Bonetti MG, Amurri B. Iron overload in thalassemia: comparative analysis of magnetic resonance imaging, serum ferritin and iron content of the liver. Haematologica. 1995;80:398-404.

Olivieri NF, Brittenham GM, Matsui D, Berkovitch M, Blendis LM, Cameron RG, et al. Iron-chelation therapy with oral deferiprone in patients with thalassemia major. N England J Med. 1995;332:918-22.

Worwood, M, Cragg SJ, Jacobs A, Mclaren C, Ricketts C, Economidou J. Binding of serum ferritin to concanavalin A: patients with homozygousbeta thalassaemia and transfusional iron overload. Br J Haematol. 1980;46:409-16.

Azarkeivan A, Hashemieh M, Akhlaghpoor S, Shirkavand A, Yaseri M, Sheibani K. Relation between serum ferritin and liver and heart MRI T2* in beta thalassaemia major patients. East Mediterr Health J. 2013;19(8):727-32.

Sengsuk C, Tangvarasittichai O, Chantanaskulwong P, Pimanprom A, Wantaneeyawong S, Choowet A et al. Association of iron overload with oxidative stress, hepatic damage and dyslipidemia in transfusion-dependent β-Thalassemia/HbE Patients. Indian J Clin Biochem. 2014;29(3):298-305.

Jensen PD, Jensen FT, Christensen T, Nielsen JL, Ellegaard J. Relationship 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(1):91-6.

Angelucci E, Muretto P, Nicolucci A, Baronciani D, Erer B, Gaziev J, et al. Effects of iron overload and hepatitis C virus positivity in determining progression of liver fibrosis in thalassemia following bone marrow transplantation. Blood. 2002;100(1):17-21.

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Published

2016-12-22

How to Cite

Jain, S., Mehta, N., & Thora, S. (2016). A study of serum ferritin, alanine transaminase and hepatic MRI T2* values in β-thalassemia major patients. International Journal of Contemporary Pediatrics, 3(4), 1367–1370. https://doi.org/10.18203/2349-3291.ijcp20163679

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Original Research Articles