Serum ferritin levels and it’s correlation with cardiac iron overload with the help of cardiac T2* magnetic resonance imaging

Shailaja V. Mane, Sharad Agarkhedkar, Dyaneshwar Upase, Tushar Kalekar, P. Sindhura


Background: Frequent blood transfusions in thalassemia major is associated with iron overload in these patients. To reduce the mortality and morbidity, proper usage of iron chelators is necessary to treat iron overload. Cardiac magnetic resonance imaging (MRI) guides in quantification of iron overload in heart. The purpose of this study is to see the correlation between serum ferritin level and T2* MRI in patients with beta thalassemia major.

Methods: Period of the study is September 2018 to September 2020. Total 25 patients diagnosed with β-thalassemia major above 5 years of age were enrolled in the study. They were on regular transfusions. Cardiac T2* MRI was done in these patients and correlated with serum ferritin levels.

Results: There was no significant correlation observed between cardiac T2* MRI and serum ferritin values (p=0.66, r=-0.094).

Conclusions: Our results showed no significant correlation between serum ferritin and cardiac T2* MRI values. Ferritin alone cannot be used as index of myocardial iron overload in thalassemia major.


Iron chelators, Iron overload, Serum ferritin, T2* MRI

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Vichinsky EP. Changing patterns of thalassemia worldwide. Ann N Y Acad Sci. 2005;1054:18-24.

Sukumaran PK. Abnormal hemoglobins in India. In: Trends in Hematology. 2007;225-36.

Borgna-Pignatti C, Cappellini MD, De Stephano P, Del Vecchio GC, Forni GL, Gamberini MR et al. Survival and complications in thalassemia. Ann NY Acad Sci. 2005;1054:40-7.

Skinner C, Kenmure AC. Haemochromatosis presenting as congestive cardiomyopathy and responding to venesection. Br Heart J. 1973;35:466-8.

Pepe A, Meloni A, Capra M. Deferasirox, deferiprone and deferoxamine treatment in thalassemia major patients: cardiac iron and function comparison determined by quantitative magnetic resonance imaging. Haemotogica. 2011;96:41-7.

Deborah Chirnomas S, Geukes-Foppen M, Barry K, Braunstein J, Kalish LA, Neufeld EJ et al. Practical implications of liver and heart iron load assessment by T2*-MRI in children and adults with transfusion-dependent anemias. Am J Hematol. 2008;83(10):781-3.

Ikram N, Hassan K, Younas M, Amanat S. Ferritin Levels in Patients of Beta Thalassaemia Major. Int J Pathol. 2004;2(2):71-4.

Choudhry VP, Pati HP, Saxena A. Deferiprone, efficacy and safety. The Indian J Pediatr. 2004;71:213-6.

Borgna-Pignatti C, Rugolotto S, De Stefano P. Survival and complications in patients with thalassemia major treated with transfusion and deferoxamine. Haematologica. 2004;89:1187-93.

Wahidiyat PA, Liauw F, Sekarsari D, Putriasih SA, Berdoukas V, Pennell DJ. Evaluation of cardiac and hepatic iron overload in thalassemia major patients with T2* magnetic resonance imaging. Hematology. 2017;22(8):501-7.

Chaosuwannakit N, Makarawate P. The value of magnetic resonance imaging in evaluation of myocardial and liver iron overload in a thalassaemia endemic population: a report from Northeastern Thailand. Pol J Radiol. 2019;84:262-8.

Vogiatzi MG, Macklin EA, Trachtenberg FL. Differences in the prevalence of growth, endocrine and vitamin D abnormalities among the various thalassemia syndromes in North America. Br J Haematol. 2009;146(5):546-56.

Hashemi A, Ghilian R, Golestan M. The study of growth in thalassaemic patients and its correlation with serum ferritin level. IJPHO. 2011;1(4):147-51.

Shah N, Mishra A, Chauhan D, Vora C, Shah NR. Study on effectiveness of transfusion program in thalassemia major patients receiving multiple blood transfusions at a transfusion centre in Western India. Asian J Transfus Sci. 2010;4(2):94¬-8.

Bandyopadhyay U, Kundu D, Sinha A. Conservative management of Beta-thalassemia major cases in the sub-division level hospital of rural West Bengal, India. J Nat Sci Biol Med. 2013;4:108-12.

Fahmy HS, Khater NH, El Shahat HM, Madani AA, El Hadidy SS. Reassessing the value of MRI T2* in evaluation of hepatic and myocardial iron concentration: An institutional study. Egypt J Radiol Nucl Med. 2015;(46):1085-90.

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 ß-thalassemia. Iran J Ped Hematol Oncol. 2014;(4):1721.

Majd Z, Haghpanah S, Ajami GH, Matin S, Namazi H, Bardestani M et al. Serum ferritin levels correlation with heart and liver MRI and LIC in patients with transfusion-dependent thalassemia. Iran Red Crescent Med J. 2015;(17):24959.