Non Transferrin Bound Labile Plasma Iron and Iron Overload in Sickle Cell Disease: a Comparative Study Between Sickle Cell Disease and β Thalassemic Patients.

Abstract

Abstract 4625 BACKGROUNDBlood transfusions are the standard of care in β thalassemia and transfusions are also indicated in Sickle Cell Disease (SCD) patients with hypersplenism, recurrent vaso-occlusive crises and for stroke prevention. Iron overload caused by blood transfusions in thalassemia and in SCD may affect morbidity and mortality. Recent studies of iron overload in SCD suggest that the biologic features of SCD and the chronic inflammatory state may protect SCD patients from iron damage. DESIGNS AND METHODSIn view of the controversy regarding the effect of iron overload in patients with SCD we studied the iron status, including non transferrin bound iron (NTBI) and labile plasma iron (LPI) levels in a cohort of thirty six SCD patients and compare the results with 43 thalassemia patients. RESULTSOur results indicate that none of the SCD patients had clinical symptoms of iron overload. Only two SCD patients had NTBI values in the grey zone (0.4 units) and none had positive values. By contrast, 14 patients with Thalassemia Major and 3 with Thalassemia Intermedia had NTBI values above 0.6, level that are in the positive pathological range. Similarly, four thalassemia patients, but only one SCD patient had positive LPI levels. CONCLUSIONSThe parameters of iron status in SCD patients, even after frequent transfusions are different when compared to patients with thalassemia. The low NTBI and LPI levels found in patients with SCD are in keeping with the absence of clinical signs of iron overload in this disease.TableIron overload in Sickle Cell Disease and β thalassemia - Laboratory data.Sickle Cell Diseaseβ Thalassemiap *SSSβThalTotal SCDβTh Mβ TITotal β ThalassemiaHgb (gr/dl)8.9±1.58.3±18.7±1.38.3±0.98.2±18.3±0.90.171Serum Iron (μg/dl)97±37110±51102±43209±50150±57** [0.007]195±57<0.001Serum Transferrin (μg/dl)209±36194±28203±33148±31141±24 [<0.001]146±29<0.001Transferrin Saturation(%)33±1638±1735±1796±1773±28** [<0.001]91±22<0.001Ferritin (ng/dl)1083±15281361±14941202±14983388±23442354±2105 [NS]3149±2306<0.001Patients studied ¶16 / 2113 / 1529 / 3629 / 308 / 1337 / 43NTBI (units)0.0±0.1 (0)0.0±0.1 (0)0.0±0.1 (0)0.56±0.52 (14)0.5±0.65 (3) [<0.001]0.55±0.54 (17)<0.001 #LPI (units)0.1±0.2 (1)0.0±0.1 (0)0.1±0.1 (1)0.22±0.33 (3)0.2±0.35 (1)0.21±0.33 (4)0.017DCI (units)0.0±0.0 (0)0.0±0.0 (0)0.0±0.0 (0)0.14±0.36 (4)0.0±0.0 (0) [0.07]0.11±0.33 (4)0.066p = p value between SCD and β Thalassemia.[ ] p between ThI and SCD.The results were expressed as mean ± SD. () = No of patients with positive values (>0.7).SCD: Sickle Cell Disease, SS: Homozygous Sickle Cell, SβThal: Sickle Cell β Thalassemia. β ThM: β Thalassemia Major, β TI: β Thalassemia Intermedia.**p= 0.005 between αThM and β TI.¶¶= N0 of patients studied by NTBI, LPI and DCI analysis.#= p <0.01 (x2 test) – No of patients with positive NTBI, thalassemia vs SCD. Disclosures:Koren:Novartis Oncology: Research Funding. Levin:Novartis Oncology: Research Funding.