Initial Serum Ferritin Levels Research Articles

“Serum ferritin – a nutritional marker for Anorexia Nervosa?”

Introduction: A new marker that correlates with nutritional recovery in Anorexia Nervosa would be of great value. Our study aimed to analyse the influence of Body Mass Index variations on serum ferritin levels in adolescents with Anorexia Nervosa followed up in a specialised consultation. Methods: We conducted a retrospective, observational, single-centre study in adolescents with Anorexia Nervosa evaluated between 2011 and 2019. Serum ferritin values ​​at baseline and during follow-up were analysed, together with the corresponding Body Mass Index (BMI) and Z-Score values. Further analytical data such as hematological and inflammatory markers were recorded. Results: The study included 53 adolescents with Anorexia Nervosa. Patients were found to have higher initial serum ferritin levels compared to the last, under treatment, assessed values (p<0.001). There was a significant increase in BMI and BMI Z-Score during follow-up (p<0.001), reflecting nutritional recovery. Analysing the variation of these values, we found a negative linear association between the variation of serum ferritin and the variation of BMI Z-Score (ß -0.1; R2 0,39; p<0,001). In analysing the change of BMI Z-Score and serum ferritin as a function of time, a linear regression model was used (ß -0,39; R2 0,12; p <0,001), showing that the quicker the recovery of BMI Z-Score, the faster the decrease in ferritin value. None of the patients presented anaemia, and in most cases, the other inflammatory markers remained normal. Conclusion: Serum ferritin could be of value in the evaluation of patients with Anorexia Nervosa in the absence of other diseases, in particular when other markers of malnutrition are normal.

The usefulness of initial serum ferritin level as a predictor of in-hospital mortality in STEMI.

Several studies have shown that elevated serum ferritin level is associated with a higher risk of coronary artery disease. Recently, it has been shown that high serum ferritin levels in men are independently correlated with an increased risk of cardiovascular mortality. This study aimed to investigate the possible correlation between the initial serum ferritin level and in-hospital mortality in patients presenting with ST-elevation myocardial infarction (STEMI). This retrospective cohort study included 890 patients who presented with acute STEMI and underwent successful primary percutaneous coronary intervention (PPCI) according to the standard techniques during the period from 1 May 2020 to 1 May 2021. At the time of admission, an initial serum ferritin level was measured in all patients. Comparison between initial ferritin levels was made between two groups: died and survived. Propensity matching was performed to exclude confounding factors effect. Forty-one patients had in-hospital mortality. There was no significant difference between both groups regarding baseline clinical characteristics. Initial serum ferritin levels were higher in deceased patients, even after propensity matching. In conclusion, even after propensity matching, initial ferritin levels were significantly higher in patients who died after being admitted for STEMI.

The relationship between plasminogen activator inhibitor-1 levels and the course of disease in COVID-19 patients

Abstract Objectives Studies have shown that fibrinolysis activity is insufficient in COVID-19 patients. Plasminogen activator inhibitor-1 (PAI-1) is an important antifibrinolytic molecule that plays a key role in the fibrinolytic system. In our study; we aimed to evaluate serum PAI-1 and other biochemical parameters of COVID-19 patients in terms of disease course and mortality. Methods A total of 40 COVID-19 patients were hospitalized in the service and intensive care unit (ICU) of our hospital from October to December 2020 and 20 healthy volunteers were included in our study. The patients were grouped as those who transferred to the ICU from the service and transferred to service from the ICU. The first and second values of the same patients in both the service and the ICU were analyzed by SPSS. Results The PAI-1 levels of the patients in the ICU were significantly higher than the levels of the same patients in the service and the healthy control group (p<0.001). IL-6, ferritin, and D-dimer levels in the ICU of the same patients were significantly higher than the levels of service and healthy control group (p<0.001). A positive correlation was found between initial serum PAI-1 and D-dimer levels in patients hospitalized in the service (p=0.039) and initial serum ferritin and IL-6 levels in the ICU (p=0.031). Conclusions In our study, we found that PAI-1 levels increased significantly with the increase in mortality in COVID-19 patients.

Clinical features, prognostic factors, and survival of patients with antisynthetase syndrome and interstitial lung disease.

ObjectiveThis study aimed to analyze the clinical features and prognostic factors of imaging progression and survival in patients with antisynthetase syndrome (ASS) complicated by interstitial lung disease (ILD) in a large Chinese cohort.MethodsMedical records, imaging, and serological data of 111 patients with ASS-ILD (positive for at least one of the following autoantibodies: anti-Jo1, anti-PL7, anti-PL12, and anti-EJ) from the Affiliated Yantai Yuhuangding Hospital of Qingdao University database were retrospectively investigated. According to the changes in high-resolution computed tomography (HRCT) outcomes at 1 year follow-up, Patients were categorized into three groups: the regression, stability, and deterioration groups. Univariate analysis was performed to evaluate the possible prognostic factors of ILD outcome and death, and multivariate analysis was performed to determine the independent predictors of ASS-ILD outcome and death by logistic regression.ResultsThe number of CD3-CD19+ cells and initial glucocorticoid dosage were correlated with imaging progression, and may be independent risk factors for ILD deterioration. Dyspnea as the first symptom, hypohemoglobinemia, the serum ferritin level, oxygen partial pressure at diagnosis, and different treatment types were important factors affecting survival, and the initial serum ferritin level may be an independent risk factor for survival.ConclusionsThe clinical characteristics of patients with ASS-ILD with different antisynthetase antibody subtypes are different. An increase in the CD3-CD19+ cell level is an independent risk factor for the deterioration of HRCT imaging. Early intensive treatment with high-dose glucocorticoids can effectively improve imaging prognosis of ILD. Patients with significantly elevated serum ferritin levels should be treated intensively.

Initial serum ferritin level as a predictor of in-hospital mortality in patients presented by ST-elevation myocardial infarction

Background and Aims : In addition to iron homeostasis, an iron-storage protein, ferritin, plays a role in various pathological conditions including inflammatory and malignant diseases. Several studies showed that elevated serum ferritin level was associated with a higher risk of coronary artery disease. Recently, it has been shown that high serum ferritin levels in men independently correlated with an increased risk of cardiovascular mortality. The study aimed to investigate the possible correlation between the initial serum ferritin level and the in-hospital mortality in patients presented by ST-elevation myocardial infarction (STEMI).

The Clinical and Biological Manifestations in Women with Iron Deficiency Without Anemia Compared to Iron Deficiency Anemia in a General Internal Medicine Setting: A Retrospective Cohort Study.

PurposeThe clinical presentation of iron deficiency is not well understood. We aimed to identify the clinical manifestations of iron deficiency without anemia in women.Patients and MethodsWe conducted a retrospective cohort study of women who visited the general internal medicine outpatient department of a university hospital in Japan between 2016 and 2022. Women who were prescribed iron supplements were included in the study. Anemia was defined as hemoglobin levels below 12 g/dl. Iron deficiency was defined as serum ferritin levels < 30.0 μg/l. The primary outcome was the difference in symptoms between patients with iron deficiency with and without anemia. The secondary outcome was the ratio of symptom, hemoglobin, and serum ferritin improvement (levels > 30.0 μg/l after treatment), comparing the measurements at the beginning and after supplementation.ResultsA total of 147 women were included in the final analysis. There were no significant differences in the initial symptoms and the ratio of symptom improvement between the groups. Compared to patients with iron deficiency anemia, patients with iron deficiency without anemia had high initial serum ferritin levels (14.8 vs 7.1 μg/l, p<0.001), and hemoglobin (13.2 vs 9.9 g/dl, p<0.001). Iron supplements significantly improved the serum ferritin level in two groups and the hemoglobin in iron deficiency anemia. After treatment, iron deficiency without anemia still had high serum ferritin levels (37.7 vs 28.2 μg/l, p=0.017) and hemoglobin (13.3 vs 12.3 g/dl, p < 0.001).ConclusionThere were no differences in any of the investigated symptoms and the ratio of the symptom improvement depending on the anemic state in iron deficiency. After iron supplementation, the serum ferritin levels in the iron deficiency without anemia group improved. Hemoglobin and serum ferritin in iron deficiency without anemia were still highly comparable to that of iron deficiency anemia.

Early High-Dose Methylprednisolone Therapy Is Associated with Better Outcomes in Children with Acute Necrotizing Encephalopathy.

Background: The neurologic outcomes of acute necrotizing encephalopathy (ANE) are very poor, with a mortality rate of up to 40% and fewer than 10% of patients surviving without neurologic deficits. Steroid and immunoglobulin treatments have been the most commonly used options for ANE, but their therapeutic efficacy is still controversial. Method: We retrospectively reviewed the medical records of 26 children diagnosed with ANE. We also divided these patients into two groups: 21 patients with brainstem involvement and 8 patients without brainstem involvement. Pulse steroid therapy (methylprednisolone at 30 mg/kg/day for 3 days) and intravenous immunoglobulin (2 g/kg for 2–5 days) were administered to treat ANE. Results: The overall mortality rate was 42.3%, and patients who did not survive had significantly higher initial lactate and serum ferritin levels, as well as higher rates of inotropic agent use with brainstem involvement. There were no significant differences in the outcomes of pulse steroid therapy or pulse steroid plus immunoglobulin between survivors and non-survivors. When analyzing the time between symptom onset and usage of pulse steroid therapy, pulse steroid therapy used within 24 h after the onset of ANE resulted in significantly better outcomes (p = 0.039). In patients with brainstem involvement, the outcome was not correlated with pulse steroid therapy, early pulse steroid therapy, or pulse steroid therapy combined with immunoglobulin. All patients without brainstem involvement received “early pulse methylprednisolone” therapy, and 87.5% (7/8) of these patients had a good neurologic outcome. Conclusion: Pulse steroid therapy (methylprednisolone at 30 mg/kg/day for 3 days) administered within 24 h after the onset of ANE may be correlated with a good prognosis. Further studies are needed to establish a consensus guideline for this fulminant disease.

Immunoadsorption for heart failure is associated with normalization of iron metabolism

Aims In heart failure (HF) patients, early stages are associated with increased iron levels, whereas iron deficiency is a common feature of chronic HF. We investigated the acute and long-term changes in iron metabolism in HF patients after immunoadsorption treatment and intravenous immunoglobulin (IVIG) administration. Methods and results Twenty-seven patients with HF with reduced ejection fraction (HFrEF) received a single cycle of immunoadsorption followed by IVIG administration. Left ventricular ejection fraction (LVEF) and iron biomarker (ferritin, hepcidin and interleukin-6) were evaluated at baseline, after immunoadsorption and during long-term follow-up of 29.3 months. LVEF improved significantly after immunoadsorption treatment from baseline 27% to 43% at long-term follow-up. Ferritin decreased from baseline 300.2 to 201.3 ng/mL (p < 0.0001) during immunoadsorption treatment and normalized during long-term to 207.9 ng/mL. Hepcidin showed a V-shaped course, with a significant decrease after immunoadsorption and normalization during long-term. Interleukin-6 levels showed no relevant inflammation. Conclusions Our data suggest that initial high serum ferritin and hepcidin levels indicate elevated iron levels characteristic of early stages of HFrEF, without inflammation. Normalization of hepcidin and ferritin was paralleled by restoration of systolic cardiac function after immunoadsorption treatment, without development of iron deficiency, as usually observed in chronic HF.

Deferasirox Effect on Serum Ferritin in Iraq Patients with Hemoglobinopathies: A Single Center Experience

BACKGROUND: The introduction of deferasirox as an oral iron chelator for hemoglobinopathies has been hailed by many as an important milestone in the management of iron overload in the latter disorders.&#x0D; AIM: The objectives of the study were to evaluate the effectiveness of deferasirox in patients with hemoglobinopathies and to assess predictors of response.&#x0D; METHODS: In this cross-sectional study, 160 patients diagnosed with hemoglobinopathies were included retrospectively from Jin hematology and oncology center in Duhok city, Iraqi Kurdistan. The Jin center offers patients with hemoglobinopathies clinical advice, examination, follow-up, treatment, and blood transfusions.&#x0D; RESULTS: The median age of enrolled patients was 12 years (range 3–34 years), and included 86 females and 74 males. All patients were on deferasirox with a compliance rate of 77.5%. Furthermore, 32.3% were on concomitant deferoxamine at their last follow-up. After a median follow-up of 2.1 years (range 1–4 years), there was a mean reduction of serum ferritin level of −478.7 overall and −821.1 ng/ml in complaint patients (both being significant at p of 0.042 and 0.001, respectively). Univariate analysis revealed that older age at enrollment, and older age at starting therapy, and initial serum ferritin (&gt;3000 ng/ml) were all significantly associated with more mean reduction in serum ferritin; while only the latter remained so by multivariate analysis (p = 0.04).&#x0D; CONCLUSIONS: Deferasirox was found to be effective in reducing the level of serum ferritin among this cohort of hemoglobinopathy patients, to a degree comparable to that reported in other studies worldwide. Furthermore, there were significant associations between the reduction of serum ferritin level and age, age at starting treatment, drug compliance, and the initial serum ferritin levels.

Long-Term Prognosis of Hyperferritinemia Induced by Intravenous Iron Therapy in Patients Undergoing Maintenance Hemodialysis: A 10-Year, Single-Center Study.

Optimal ferritin level in hemodialysis patients between Japan and other countries is controversial. Long-term side effects of iron supplementation in these patients remain unclear. We aimed to elucidate whether past hyperferritinemia in hemodialysis patients was associated with high risk of death and cerebrovascular and cardiovascular diseases (CCVDs). This small retrospective cohort study included approximately 44 patients unintentionally supplemented with excessive intravenous iron. A significantly higher risk of CCVDs was observed in patients with initial serum ferritin levels ≥1000 ng/mL than in the remaining patients. High ferritin levels slowly decreased to <300 ng/mL in a median of 24.2 (10.5–46.5) months without treatment. However, compared with the remaining patients, only patients whose ferritin levels did not decrease to <300 ng/mL steadily had a significantly higher risk of all-cause death (hazard ratio, 9.6). Long-term hyperferritinemia due to intravenous iron therapy is a risk factor for death in maintenance hemodialysis patients. For a prolonged better prognosis, intravenous iron should be carefully administered so as to avoid hyperferritinemia in patients with hemodialysis.

Comparative study of Deferiprone versus Deferiprone with Deferasirox as iron chelation therapy in Thalassemic children

Background: Combination therapy of Deferiprone (DFP) with Deferasirox (DFX) is an efficacious and safe modality to reduce serum ferritin in multi-transfused children with thalassemia.&#x0D; Objectives: To compare the efficacy of Deferiprone versus Deferiprone with Deferasirox as iron chelation therapy of transfusion dependent thalassemia children.&#x0D; Materials and Methods: A non-randomized control clinical trial was done in department of Pediatric Hematology and Oncology, Dhaka Medical College Hospital and Bangladesh Thalassemia Hospital in Dhaka during the period of October 2016 to September 2017. Thirty children with transfusion dependent thalassemia major between 3 to 12 years of age were included in each group in this study. Children with thalassemia minor, after splenectomy, with comorbidities and on other iron chelation therapy were excluded from this study.&#x0D; Results: Among total enrolled 60 cases in this study, initial mean serum ferritin level was 3397.48 ± 774.48 ng/ml in DFP-monotherapy group and 3413.70 ± 1114.05ng/ ml in DFP-DFX combination group. Mean serum ferritin level at 6thmonth was found 2730.63 ± 839.91ng/ml in DFP-monotherapy group and 1654.20 ± 934.90 ng/ml in DFP-DFX-combination group which shows rapid reduction of serum ferritin level in DFP-DFX-combination group. 12 (40.0%) patients had arthralgia in DFPmonotherapy group and 5(16.7%) patients had vomiting in DFP-DFX-combination group. No abnormalities seen in liver and renal function tests.&#x0D; Conclusion: Combination therapy with Deferiprone and Deferasirox is more effective in reduction of iron overload and drug related complications in transfusion dependent thalassemia patients.&#x0D; Bangladesh J Child Health 2019; VOL 43 (3) :152-156

Evaluation of clinical prognostic factors for interstitial pneumonia in anti-MDA5 antibody-positive dermatomyositis patients

Objectives: We retrospectively investigated clinical prognostic factors for interstitial pneumonia (IP) in anti-melanoma differentiation-associated gene 5 (MDA5) antibody (Ab)-positive dermatomyositis (DM) patients.Methods: Subjects comprised 18 patients with anti-MDA5 Ab-positive DM-IP (9 survivors; 9 deaths).Results: Initial serum albumin levels, ferritin levels, and ground-glass opacity (GGO) scores in the right middle lobes were significantly higher in the death group than in the survivor group (p = .033, .013, and .005, respectively). Initial alveolar-arterial oxygen gradient (P[A-a]O2) was also higher in the death group than in the survivor group (p = .064). Initial serum ferritin, P[A-a]O2, and right middle lobe GGO score were found to significantly relate to death. Survival rates after 24 weeks were significantly lower among patients with an initial ferritin level of ≥450 ng/mL (25%), P[A-a]O2 of ≥30 mmHg (31%), and a right middle lobe GGO score of ≥2 (11%) than each of the others (p = .006, .020, and .002, respectively).Conclusions: An initial serum ferritin level of ≥450 ng/mL, P[A-a]O2 of ≥30 mmHg, and right middle lobe GGO score of ≥2 (GGO ≥5% of the lobe) were identified as poor prognostic factors for anti-MDA5 Ab-positive DM-IP patients.

Comparative Study of Deferiprone and Silymarin versus Deferiprone and Placebo as Iron Chelators in Children with Beta Thalassemia with Iron Overload

Background: Beta thalassemia is an inherited hemoglobin disorder resulting in chronic hemolytic anemia requiring life-long blood transfusion that cause iron overload. Silymarin plays a role as an iron chelator in iron overloaded patients. The aim of this work was to compare the iron chelating efficacy of combination therapy of oral Deferiprone and silymarin with oral Deferiprone and placebo. Patients and methods: This study was conducted on 40 children with beta thalassemia major under follow up at Hematology Unit, Pediatric Department, Tanta University Hospital in the period between October 2012 and October 2013 with their serum ferritin levels more than 1000 ng/ml and they was divided in two groups. Group I: Received oral Deferiprone and silymarin for 6 months. Group II: Received oral Deferiprone and placebo for 6 months. Results: In the current study, there were no significant differences in the initial serum ferritin, serum iron and TIBC levels between group I and group II but after regular chelation therapy, serum ferritin and serum iron were significantly lower and TIBC was significantly higher in group I than group II. No statistically significant difference in serum creatinine, blood urea, ALT, AST and serum bilirubin levels between Group I and Group II before and after chelation therapy. Conclusion: From this study we concluded that, Deferiprone in combination with silymarin are better iron chelators in iron-loaded thalassemic patients than Deferiprone and placebo.

Efficacy And Safety Of Administration Of Oral Iron Chelator Deferiprone In Patients With Early Myelodysplastic Syndrome

Forty-eight patients with early myelodysplastic syndrome (MDS) without excess of blasts, with average initial serum ferritin levels of 2739.5 μg/L (range 825–11287 μg/L), were treated with deferiprone (L1) in a daily dose of 40–90 mg/kg. Median duration of chelation treatment was 10.9 months (range 4–24 months). Chelation was effective (maintained or decreased iron stores) in 16 out of 22 patients (73%) with serum ferritin levels <2000 μg/L in contrast to only 12 out of 26 patients with serum ferritin levels >2000 μg/L. Combination of L1 with recombinant human erythropoietin (rHuEPO) (30–40 kU/week) resulted in effective chelation in five additional patients with serum ferritin levels >3000 μg/L. Incidence of adverse effects was comparable to that in thalassemic patients. Gastrointestinal symptoms represented the most frequent adverse effect of L1 therapy (37.5% of patients) that limited an effective escalation of the daily dose of the drug and led to discontinuation of the treatment for six patients. A decreased number of granulocytes was observed in five (13%) patients and agranulocytosis occurred in two patients (4%). Granulocyte counts were restored after cessation of L1 treatment and administration of granulocyte colony stimulating factor (G-CSF) in all but one patient. Administration of L1 in a daily dose of at least 75 mg/kg may represent an alternative approach in treatment of mild and moderate iron overload in MDS patients who cannot be treated with deferasirox (DFRA) or deferoxamine (DFO).

Initial Serum Ferritin Level as a Predictor of Survival in Hemochromatosis

Initial Serum Ferritin Level as a Predictor of Survival in Hemochromatosis

Iron Deficiency in Division III Male Cross Country and Track Runners

The incidence of iron deficiency (without anemia) in males is 2% (CDC statistics), as compared with 14% in females. However, male distance runners and endurance athletes have increased iron losses due to excessive sweating, gastrointestinal bleeds, hematuria, and increased hemolysis due to foot strike. Iron deficiency, even with normal hemoglobin (Hb) values, may result in decreased athletic performance, decreased energy efficiency during submaximal exercise, and increased muscle fatigue. PURPOSE: To assess the iron status of male cross country and track runners and identify subjects who were iron deficient. METHODS: Subjects, males aged 18-22, completed three day diet records twice during the year which were analyzed using diet analysis software. Blood samples were collected four times during the year. Serum ferritin was measured using an ELISA procedure and hemoglobin was determined using a whole blood analysis system. RESULTS: Mean iron intake was 25 ± 9 mg in the fall and 28 ± 8 mg in the spring (RDA for males is 8 mg/day, and all subjects had intakes above the RDA for iron). Mean ferritin and hemoglobin (Hb) values are shown below.TABLESubjects who had low initial serum ferritin and Hb levels were educated to improve their dietary sources of iron and to consider the use of a vitamin/mineral supplement. CONCLUSION: The male runners in this study initially had an incidence of iron deficiency of 21.0% which is ten times the expected for this age group. The percentage of individuals with ferritin < 40 ng/ml progressively declined throughout the year (3% in May) due to screenings and education. Furthermore, different individuals developed iron deficiency at different times throughout the year, stressing the importance of repeated screenings.

Long-term efficacy of oral deferiprone in management of iron overload in beta thalassemia major

Objective: Variable response to deferiprone has been observed in the management of iron overload in patients with thalassemia major. Our objective was to assess the long-term efficacy of deferiprone in patients with thalassemia major.Methods: We analyzed the serum ferritin levels in fifty-eight patients who were on deferiprone therapy for at least three years. We divided patients into three groups based on the initial serum ferritin level: group 1, <2000 ng/ml; group 2, 2000–4000 ng/ml; group 3, <4000 ng/ml.Results: Repeated measurement analysis showed a fall in serum ferritin level in group 3 after 12 months but again increased after 24 months, whereas other groups showed an increase in serum ferritin after 12 months which was sustained for 3 years. The patients were divided into three groups depending on the comparison of serum ferritin at the beginning and at the end; response group I: patients remained in the same ferritin group (n=30), response group II: patients progressed to more severe group (n=17), response group III: serum ferritin decreased and patient shifted to the lower group of ferritin level (n=11). Comparing various factors which could affect the response to deferiprone among three groups, no factor other than serum ferritin at the beginning of the treatment showed significant effect. However, some patients with a serum ferritin value in the lower range also showed improvement.Conclusion: The major factor determining the response to deferiprone was initial serum ferritin. But some patients responded well even with relatively low initial serum ferritin.

EFFECT OF 40 DAYS SLEEPING IN NORMOBARIC HYPOXIA ON TOTAL HEMOGLOBIN MASS IN COMPETITIVE RUNNERS

Living high and training low is a concept which allegedly provides the hematological benefits accompanying the adaptation to high altitude while allowing the athlete to maintain a quality training regimen in a sea level environment. Whether or not the altitude benefits can be achieved when exposures are limited to sleeping in a simulated high altitude (HA) environment is open for debate. PURPOSE To determine plasma (PV) and red cell (RBC) volumes and total hemoglobin mass (THb) responses in runners during 40 days of sleeping in a “nitrogen house” while maintaining a vigorous training regimen at sea level. METHODS Eight elite-level distance runners (age 23 ±6 yrs; VO2max 78.2 ±3.5 mL.kg−1.min−1) spent 8–10 hrs/night in HA ranging from 1980 to 3650 m; three controls (C) lived at sea level. The runners exposed to normobaric hypoxia and the C subjects trained at sea level throughout the experimental period. Blood volume and THb were determined by the CO method before and again after 41.7 ±5.9 days of HA. RESULTS Results are presented in the Table (mean ±S.E.; *p < 0.05). Initial and 40-day serum ferritin levels for the HA group averaged 75 ±45 and 68 ±40 ng·mL > −1, respectively. The significant increase in Hct with HA was the combined effect of slight increases (NS) in RBC and THb, and a decrease (NS) in PV. CONCLUSION Forty nights sleeping 8–10 hours in HA elicited both a significant fluid shift(hemoconcentration) and the suggestion of increases in RBC and THb. However, changes in the latter parameters were NS and the effectiveness of this regimen for increasing the oxygen carrying capacity of the blood remains equivocal.Table: No Caption Available

Efficacy and Side Effects of Deferiprone (L1) in Thalassemia Patients Not Compliant with Desferrioxamine

We report our experience with deferiprone (L1) (DFP) in 17 thalassemic patients, followed up in one center in Lebanon, who were initially on desferrioxamine and then shifted to DFP at a dose of 50–75 mg/kg/day as the sole chelator during 1-year follow-up. All 17 patients were compliant with therapy and there was no change in physical examination over the study period. Eight patients (47.1%) were positive for hepatitis C virus (HCV) antibodies. Urinary iron excretion was 21.8 ± 14 mg/24 h (mean ± SD) 1 week after starting DFP and dropped 12 months later to 13 ± 7.4 mg/24 h (p = 0.009, paired t test). The initial serum ferritin level was 3,863 ± 2,344 μg/l which dropped to 3,179 ± 2,075 at 12 months after starting therapy (p = 0.07). HCV-negative patients as a group exhibited a significant decrease in serum ferritin after 6 and 12 months of DFP therapy (3,942 ± 2,739 vs. 2,341 ± 1,179 and 2,681 ± 1,519 μg/l; p < 0.03 and p < 0.05, respectively). The most frequent side effects were joint pain, stiffness or swelling in 6 patients (35.3%), and nausea in 7 patients (41.2%), but these were well tolerated and did not require stopping treatment.

Initial serum ferritin levels in patients with multiple trauma and the subsequent development of acute respiratory distress syndrome.

Acute respiratory distress syndrome (ARDS) represents a catastrophic form of inflammatory lung injury that occurs unpredictably in some, but not all, at-risk patients. In this study, we investigated serum ferritin as a marker for ARDS development in a homogenous group of patients at-risk because of multiple trauma. We hypothesized that since ferritin synthesis is increased by proinflammatory cytokines, which are increased and implicated in ARDS, that ferritin levels would increase and that ferritin increases would correlate with the degree of inflammation and therefore the development of ARDS. We studied 42 patients (25 male, 17 female) who as a consequence of multiple trauma became at-risk for developing ARDS. Using the European/American Consensus definition for ARDS, 16 (38%) patients subsequently developed ARDS (11 male and five female). We found that initial serum ferritin levels correlated with the subsequent development of both ARDS (progression to ARDS, median = 638 ng/ml; (range, 70 to 4,500) versus nonprogression to ARDS = 185 ng/ml; range, 12 to 2,850) (p = 0.02, r = -0.27) and multiple organ failure (p < 0.05, r = 0.39). Using our previously established cutoff points for serum ferritin, the positive predictive value was 62% for men and 75% for women. Initial serum ferritin levels also correlated with a measurement of the degree of initial trauma injury, i.e., the injury severity score (ISS) (p < 0.05, r = 0.37). However, there was no correlation between serum ferritin levels and other markers of clinical injury, namely, lowest PaO2/FIO2 ratio (p = 0.67), days requiring ventilation (p = 0.09), or mortality (p = 0.42). A significant association existed between serum ferritin levels and products of endothelial activation, i.e., sE-selectin (p < 0.04, r = 0.37) and sICAM-1 (p < 0.01, r = 0.21). In the future, with the development of novel anti-inflammatory therapies, early identification of specific high-risk patients would allow the institution of these therapies and thereby increase the chances of reducing ARDS morbidity and mortality.