Aims and objectives
Pre and post allo transplant iron overload (IO) has been associated with considerable long-term morbility and mortality1,2.
Classically,
its management has been based in therapeutic phlebotomies (TP),
often inconvenient and not feasible due to ongoing anemia.
Therefore,
it is crucial to diagnose IO before allogenic hematopoietic stem-cell transplant (allo-HSCT).
Serumferritin (SF) level is widely used to assess IO but its elevation might be nonspecific.
Measurement of liver iron concentration (LIC) by MRI has been proved to be a noninvasive and reliable technique to evaluate iron...
Methods and materials
This is a prospective study including 26 patients admitted for an inmediate allo-HSCT.
SF level,
transfused PRBC and other clinical data were registered.
An MRI was performed the day of admission to evaluate LIC.
An accurate and validated Signal Intensity Ratio (SIR) model with two Gradient Echo sequences (120,4,20º (TR,TE,Flip angle)) was employed and T2* values were measured3.
T2* values were obtained in 3 regions of interest (ROIs) placed in right liver lobe avoiding big vessels. Final reported values were obtained as the average of...
Results
Patients had received a median of 23.5 PRBC (IQR: 15-30).
Median SF was 1368 ng/mL (IQR: 882-1930) and median LIC measured by MRI was 52.9 mmol/mg (IQR: 21.5-87.4).
All patients (6/6) who had received less than 20 PRBC and had a SF level below 1000ng/mL,
did not have IO.
On the contrary,
from those who had received more than 20 PRBC and had aSF level over 1000 ng/mL,
almost all (14/15) had moderate liver iron overload (LIC>36 mmol/gr).
Three out of the five patients who...
Conclusion
We conclude from our results that:
1) A positive correlation was found between PRBC and SF with LIC.
Patients with PRBC<20 and SF<1000 ng/mL did not have iron overload.
On the other hand,
patients with PRBC>20 and SF>1000 ng/mL did have iron overload.
Therefore,
performing liver MRI for LIC measurement would not be necessary.
2) In patients with non-coincident markers,
measurement of LIC by MRI would be useful to evaluate real iron overload and decide subsequent management of patients.
References
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