IRON OVERLOAD IN THALASSEMIA - COMPARATIVE-ANALYSIS OF MAGNETIC-RESONANCE-IMAGING, SERUM FERRITIN AND IRON CONTENT OF THE LIVER

Background. Iron overload in patients with thalassemia is a common fea ture which requires continuous chelation therapy and monitoring. Serum ferritin determination is widely accepted as a simple method for foll owing iron load in patients with primary hemochromatosis; however, sev eral reports on thalassemic patients emphasize that ferritinemia is no t accurate and that other methods such as direct measurement of iron i n the liver (HIC) and magnetic resonance imaging (MRT) are more precis e. Materials ann Methods. In order to contribute to the general unders tanding of iron load in thalassemia we used liver MRI to study 33 thal assemic patients, most of whom were also evaluated for iron content by Liver biopsy. The data were then compared with serum ferritin levels. Results. Ferritin levels ranged between 276 and 8031 ng/mL, and liver iron content ranged from 1.6 to 31.0 mg/g dry weight; grade III or IV liver siderosis was recorded in 23/33 patients, just as 23/33 patient s were found to have severe or very severe siderosis at MRI. Significa nt correlations with ferritin levels were recorded between grade TV an d grades III, II and I (p < 0.01, p = 0.02, and p = 0.03, respectively ). Ferritinemia also showed significant linearity with liver iron cont ent (r = 0.603, p = 0.001). No significant differences of ferritin lev els were recorded, however, between patients found to have severe and those with mild iron load at MRI (p = 0.073). Conclusions. Our study s hows that serum ferritin levels exhibit a tendency to be significantly correlated with the true status of hemochromatosis in thalassemic pat ients; however, the discrepancies recorded in several patients and the scarce or total lack of correlation with MRI suggest exploring other approaches to this problem in order to make proper decisions about the rapy,