Median Serum Ferritin Level Research Articles

Reticulocyte-Hemoglobin Content as Marker for Iron Status in Preterm Neonates

Abstract Background Reticulocyte indices and reticulocyte hemoglobin provide a direct real time measure of hemoglobinization in newly produced erythrocytes, without perturbation by inflammation. It has been a reliable indicator of iron availability for Hb synthesis in children and adults. Aim of the Work To assess the average RET-Hb values in premature neonates soon after birth, to assess its value as marker of iron deficiency (ID) and to correlate these levels with the need for early iron supplement and/or blood transfusion. Patients and Methods This is a prospective observational study conducted at Neonatal Intensive Care Unit (NICU), Ain Shams University Children Hospital from March 2022 till September 2022. Results The study included 22 females (44.0%) and 28 males (56.0%) with mean gestational age of 31.84±1.60 weeks. The mean HGB level on admission was 16.76 ± 2.16 mg/dL, with 24.0% of neonates having an HGB level <15 mg/dL and the mean Ret-HB level for preterm neonates was 31.70 ± 2.68 pg/cell. The median serum ferritin level was 168 (IQR: 125 – 225) ng/mL and ferritin was positively correlated with Ret-Hb. Almost 58% (n = 29) required iron supplements in the first 2-4 weeks of life and 64% of neonates required packed red cell transfusion during their hospitalization. Ret-Hb at a cut off level of ≤ 30.4 pg/cell can predict early enteral iron supplement among the studied group at the cut off level with sensitivity of 52.4%, specificity of 75.9% and with a cut off level < 30.8pg/cell can predict the need for blood transfusion among the studied group with sensitivity of 56.25% and specificity of 83.33%. Conclusion Ret-Hb levels in preterm neonates was significantly correlated with ferritin levels. Ret-Hb could be a reliable marker of iron deficiency and helps in early enteral iron supplement for this age group but normal reference ranges should be standardized.

Serum ferritin is a risk factor for pulmonary dysfunction in young patients with transfusion-dependent thalassemia

Research into the pulmonary function of patients with transfusion-dependent thalassemia (TDT) is limited, with existing studies presenting conflicting results. We carried out a retrospective study involving 140 patients with TDT. The mean patient age was 8.7 ± 3.2 years, with a median serum ferritin (SF) level of 3791.4 ng/ml (IQR: 2424.1–5733.3 ng/ml). Pulmonary function abnormalities were detected in 46.43 % (65 out of 140) of patients, primarily manifesting as diffusion dysfunction (26.43 %), followed by ventilatory dysfunction (5.0 %), and mixed pulmonary dysfunction (15.0 %). A serum ferritin level above 2500 ng/ml significantly correlated with the occurrence of these abnormalities(OR = 3.187, 95%CI:1.312–7.741, P = 0.010), while higher hemoglobin concentrations demonstrated a protective effect (OR = 0.966, 95%CI: 0.943–0.989, P = 0.004). Our study highlights diffusion dysfunction as the most prevalent type of pulmonary function abnormalities in TDT patients. Furthermore, it establishes a correlation between elevated serum ferritin levels and pulmonary dysfunction.

Serum ferritin and the risk of early-onset colorectal cancer.

The incidence of early-onset colorectal cancer (EO-CRC) is rising in the United States, and is often diagnosed at advanced stages. Low serum ferritin is often incidentally discovered in young adults, however, the indication for endoscopy in EO-CRC is unclear. To compare serum ferritin between patients with EO-CRC and healthy controls (HCs), and examine the association of serum ferritin in EO-CRC with patient- and disease-specific characteristics. A retrospective study of patients < 50 years with newly-diagnosed EO-CRC was conducted from 1/2013-12/2023. Patients were included if serum ferritin was measured within 2 years prior to 1 year following CRC histologic diagnosis. To supplement the analysis, a cohort of HCs meeting similar inclusion and exclusion criteria were identified for comparison. A sensitivity analysis including only patients with serum ferritin obtained at or before diagnosis was separately performed to minimize risk of confounding. Among 85 patients identified with EO-CRC (48 females), the median serum ferritin level was 26 ng/mL (range < 1-2759 ng/mL). Compared to HCs (n = 80211), there were a higher proportion of individuals with EO-CRC with serum ferritin < 20 ng/mL (female 65%, male 40%) versus HCs (female 32.1%, male 7.2%) age 29-39 years (P = 0.002 and P < 0.00001, respectively). Stage IV disease was associated with significantly higher serum ferritin compared to less advanced stages (P < 0.001). Serum ferritin obtained before or at the time of diagnosis was lower than levels obtained after diagnosis. Similar findings were confirmed in the sensitivity analysis. Severe iron deficiency may indicate an increased risk of EO-CRC, particularly at earlier stages. Further studies defining the optimal serum ferritin threshold and routine incorporation of serum ferritin in screening algorithms is essential to develop more effective screening strategies for EO-CRC.

Clinico-mutational profile and the impact of splenectomy in children with glucose-6-phosphate isomerase deficiency

BackgroundThere is a lack of literature on the role of splenectomy in hemolytic anemias due to glucose-6-phosphate isomerase (GPI) deficiency. GPI deficiency is a rare red blood cell (RBC) enzymopathy of the glycolytic pathway. Most present with severe disease requiring frequent transfusions. In this study, we report the effect of splenectomy in the world's largest cohort of GPI deficiency patients. The study aimed to describe the clinical, mutational, and laboratory parameters of patients with GPI deficiency. A comparison of the transfusion requirement pre- and post-splenectomy is also included. Material and methodsThe ambispective study was performed from 2017 to 2023. Patients with congenital non-spherocytic hemolytic anemia (CNSHA) were screened for GPI deficiency. Detailed history, including demographic, clinical data, and transfusion details, were noted. Hematological parameters and RBC enzyme activity were estimated using spectrophotometry. The genetic study was done using restriction fragment length polymorphism, and confirmation was obtained through Sanger's sequencing. Patients were followed up after splenectomy. ResultsEighteen patients were diagnosed with GPI deficiency. About 3/4th (14/18; 77.7 %) had significant hepatosplenomegaly. Median serum ferritin levels were 890 ng/ml. Seven patients were on oral iron chelation. The nutritional status assessed as per the Indian Academy of Pediatrics growth charts revealed significant growth retardation. All the patients had severe anemia (mean Hb: 6.4 g/dl) and macrocytosis (mean MCV: 129.2 fl). Laboratory features of hemolysis were evident with reticulocytosis, raised serum lactate dehydrogenase, and indirect bilirubin. The mean GPI enzyme activity was 28.75 IU/g Hb.Ten (55.5 %) patients underwent splenectomy at a median age of 7 years. Five remain transfusion-free post-splenectomy at a median follow-up of 54 months. Other 5 had a significant reduction in transfusion requirement post-splenectomy (p < 0.05). Post-splenectomy, the mean hemoglobin levels increased from 6.2 to 8.1 gm%, and the mean reticulocyte counts reduced from 7.4 % to 4.8 %. Fifteen of 18 had the pathogenic c.1040G > A(p.Arg347His) homozygous mutation. ConclusionThe study demonstrates the benefit of splenectomy in patients with GPI deficiency.

The Association of Serum Ferritin with Disease Severity in Non-alcoholic Fatty Liver Disease

Abstract Background NONALCOHOLIC FATTY LIVER DISEASE is emerging as the most common chronic liver condition in the Western world. It is associated with insulin resistance and frequently occurs with features of the metabolic syndrome. Disease presentation ranges from asymptomatic elevated liver enzyme levels to cirrhosis with complications of liver failure and hepatocellular carcinoma. Current treatment recommendations are limited to weight loss and exercise, although several promising medications are on the horizon. Aim of the Work The aim of this study is to evaluate the association of serum ferritin with non- alcoholic fatty liver disease. Patients and Methods The study was cross sectional study which conducted at Ain Shams University Hospital. This study was conducted on 80 patients both sexes, with age (18years old - 60 years), duration of study will be 6 months. All study patients approved to participate in this study. Patients were divided in to 2 groups as following: Results Our study reveals that patients with non alcoholic steatohepatitis (NASH) have significantly higher median serum ferritin levels, compared to those with non alcohoholic fatty liver disease (NAFLD). Also ROC curve shows that the best cutoff point of serum ferritin to differentiate between normal lipid profile group and elevated lipid profile group was found &amp;gt; 80 with sensitivity of 82.5%, specificity of 60.0% and AUC of 69.5% while the best cutoff point of fatty liver index to differentiate between normal lipid profile group and elevated lipid profile group was found &amp;gt; 89 with sensitivity of 67.5%, specificity of 80.0% and AUC of 76.8%. Conclusion Elevated serum ferritin may reflect increased disease severity in NAFLD either because of increased ongoing hepatic or systemic inflammation or increased body iron stores or a combination of these factors. Our study also reveals that patients with non alcoholic steatohepatitis (NASH) have significantly higher median serum ferritin levels, compared to those with non alcohoholic fatty liver disease (NAFLD).

Clinical management of iron deficiency anemia in Japan: iron prescription patterns, treatment effectiveness, and assessments

Iron deficiency anemia is one of the most common types of anemia, but real-world clinical management practices in Japan are unclear. This study retrospectively explored iron prescription patterns, treatment effectiveness, and assessments. Patients with at least one treatment period between September 2020 and September 2022 were included and classified into three groups (ferric carboxymaltose [FCM]: 7437 patients, saccharated ferric oxide [SFO]: 98,648 patients, and oral iron: 359,547 patients). Iron-related laboratory values over time and testing proportions were evaluated. Median baseline hemoglobin levels were lowest with FCM (FCM: 8.10 g/dL, SFO: 8.70 g/dL, oral iron: 9.70 g/dL), but changes in hemoglobin levels by 12 weeks were greatest with FCM (FCM: 3.20 g/dL, SFO: 2.60 g/dL, oral iron: 1.70 g/dL). The median serum ferritin level at 8 weeks after FCM treatment was 43.70 ng/mL for ≤500 mg, versus 123.30 ng/mL for >500 to ≤1500 mg. All groups had a low proportion of serum ferritin and transferrin saturation (TSAT) testing at diagnosis (<38%), which decreased further for post-treatment assessment (<24%). This study suggests the importance of prescribing an appropriate total iron cumulative dose per the package insert, along with diagnosis and assessments based on serum ferritin/TSAT.

Serum ferritin predicted prognosis in patients with nasopharyngeal carcinoma

Elevated serum ferritin (SF) levels have been associated with poor prognosis in various cancer types, but its impact on nasopharyngeal carcinoma (NPC) remains unclear. This retrospective study analyzed clinical data from 252 non-metastatic NPC patients admitted to Hainan General Hospital between January 2014 and May 2016. SF levels were measured using the chemiluminescence method. Patients were categorized into low, medium, and high-level SF groups based on tertile median SF levels. Survival outcomes were assessed using Kaplan–Meier analysis and Cox regression models. The overall survival rates of the entire patient cohort at 1, 3, 5, and 8 years were 95.2%, 85.7%, 76.2%, and 68.9% respectively. The high-level SF group (SF > 164.00 ng/mL) had significantly worse overall survival (83.1 vs 96.3 months, P = 0.023) and progression-free survival (77.8 vs 93.3 months, P = 0.019) compared to the low-level SF group. Univariate and multivariate analyses confirmed that high SF levels, along with T3/T4 staging and N3 staging, were independent risk factors for poor prognosis. In conclusion, high SF levels are associated with shorter overall survival and progression-free survival in NPC patients.

Efficacy and safety of deferasirox in thalassemia major patients after repeated blood transfusion: A single-center study

Background: Patients with β-thalassemia major (TM) require lifelong blood transfusions, leading to iron overload, where active intervention is required. Aims and Objectives: The aim of the study was to evaluate real-world efficacy and safety of deferasirox (DFX) in TM patients at a tertiary care teaching hospital. Materials and Methods: A prospective observational study was conducted at thalassemia ward in a tertiary care teaching hospital in Gujarat for a period of 15 months from April 2021 to July 2022. A total of 100 patients were analyzed during the study period. Patient’s demographic profile, laboratory investigation, and treatment details were analyzed using descriptive statistics. Statistical analysis was done through the statistical software GraphPad Prism 9.4.1 (681). Results: A total of 100 patients were included in the study. A serial significant decrease in median serum ferritin levels was observed in &gt;13 years age group after initiation of DFX. A significant increase in the median dose of DFX was observed at 12 months in the age group of 2–≤13 years as compared to baseline (P &lt; 0.05). Adverse reactions observed during the study were increased bilirubin level, increased alanine aminotransferase, and increased serum creatinine, rashes with itching, and arthralgia. Conclusion: A greater reduction in median serum ferritin levels was observed in the adult age group compared to pediatric patients.

Iron Deficiency in Young Children Beyond Anemia: Clinical Features, Maternal Factors, and the Predictor for Neuropsychomotor Development Delay

Introduction: Iron deficiency (ID) is the most common micronutrient deficiency in children and is prevalent in young children, especially in those with long-term exclusive breastfeeding (BF). Iron deficiency anemia (IDA), the most common type of pediatric anemia, while it is not the only clinical manifestation of ID. In Taiwan, prevalence of IDA was up to 23% in child-bearing women. It was reported that the iron levels in the breast milk of IDA mothers were markedly lower than that of non-IDA mothers. ID alone in young children can cause neurocognitive development symptoms, including inattention, psychomotor delay, cognition impairment, pica, etc, in children. However, clinical reports on ID, not IDA, are relatively few. We aimed to investigate the clinical features and influencing factors of ID in young children. Methods and Materials: There were 33 young children diagnosed as ID at outpatient department at Taipei Medical University Hospital from 2017 to 2019. The charts were retrospectively reviewed and clinical data were collected, including diagnostic age, initial symptoms, periods of breast-feeding (BF), hemoglobin (Hb), mean corpuscular volume (MCV), serum ferritin (SF), serum iron, total iron binding capacity (TIBC), zinc levels, thalassemia survey, duration of iron supplement, and laboratory improvement after iron supplement. Whether there were neuropsychomotor (NPMD) delay depended on the chart record of doctors of pediatric rehabilitation. Results: The median age of ID diagnosis was 2.5 years (range: 5 month－7.17 years). There were 31 (94%) of ID children initially presented with either koilonychias, picky eating, or poor appetite. 24 (72.7%) were found to have koilonychias, and among them, 18 (54.5%) had flat nails and 6 (18.2%) had spoon nails. 17 (51.5%) were picky eaters, 16 (48.5%) had poor appetite, 7 (21.2%) had pale nails, and 3 (9.1%) had pica. 11 (33.3%) had NPMD delay. The median duration of BF was 10.8 months (range: 0 to 36). There were 12 (36.4%) children whose mother had IDA. The median Hb was 11.2 g/dL (IQR: 10－12.65), median MCV was 76.45 fL, median SF level was 25 ng/mL (IQR: 13.25－45.5), and median transferrin saturation was 9.25% (IQR: 7－12.88). The median serum zinc level at diagnosis of ID was 66.4 μg/dL. In addition, 21 (63.6%) has concurrent zinc deficiency, 10 (30.3%) had pediatric IDA, and 2 (6.3%) had combined thalassemia trait. The median (IQR) duration of iron supplement is 3 (3-6) months. After treatment, patients' data revealed a significant increase in median Hb of 12.6 mg/dL, median MCV of 78.7 fL, median SF of 47 ng/mL, and median transferrin saturation of 15.35%. By correlation analysis, breastfeeding duration was also moderately correlated to SF level (Pearson rank=-0.5224). Maternal IDA history also had a negative correlation to SF level in ID children (Pearson rank=-0.4053). By multivariate linear regression (MVLR) analysis, breastfeeding duration and maternal IDA history were identified as significantly inverse predictors for SF levels in ID children. ID children with NPMD delay had significantly higher rate of concurrent zinc deficiency. By MVLR analysis, serum zinc level was identified as a significant inverse predictor for NPMD delay among ID children (Odd's ratio: 0.89, 95%CI: 0.799-0.991, p-value=0.0336*). Conclusion: Our results highlighted the clinical features of ID in infants and children. A high proportion of ID children had maternal IDA history (36.4%) and NPMD delay (33.3%). Iron supplementary was effective to improve ID. Breastfeeding duration and maternal IDA history can negatively impact SF level in ID children. Good levels of serum zinc in ID children can predict lower risk of NPMD delay. Disclosures : No relevant conflicts of interest to declare.

Inflammatory Markers in Hemophagocytic Lymphohistiocytosis - a Single Centre Study

BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) has significant clinical and biochemical overlap with other cytokine storm syndromes including Adult-Onset Still's disease (AOSD) and COVID-19 cytokine storm (CCS). Diagnosis of HLH is based largely on the HLH-2004 criteria which carry certain limitations. Many of the tests included in these criteria such as flow cytometry for NK cell cytotoxicity and soluble CD25 levels are only available in specialized centres. Moreover, they can take days to weeks to result, leading to delays in diagnosis. Biomarkers that are unique to HLH and more readily available are needed to ensure a timelier diagnosis of this life-threatening disease. C-reactive protein (CRP) is a sensitive marker of inflammation that is driven by IL-6 activity, a cytokine that is significantly elevated in AOSD and CCS but comparatively less so in HLH. Our study sought to determine whether lower levels of CRP, in conjunction with other patterns of inflammatory markers, could reliably distinguish HLH from AOSD and CCS. METHODS This was a single-centre, retrospective study examining adult ( n=45) and pediatric ( n=12) patients with HLH, and adult patients with AOSD ( n=11) and CCS ( n=13). Patients were enrolled from Vancouver General Hospital between January 1 st, 2000, to June 28 th, 2023. CRP and ferritin levels were collected for each patient if available, and values were included in analysis only if drawn prior to HLH-specific treatment. Ferritin levels were included to add to our understanding of different patterns of inflammation seen in similar cytokine storm syndromes. The Kruskal-Wallis test was used to compare CRP and ferritin values in total HLH cases compared to AOSD and CCS. Diagnostic performance of CRP was analyzed by performing a receiver operating characteristic (ROC) curve for CRP in HLH patients using the Youden index to identify the optimal cut-off point for CRP values. RESULTS In total, eighty-one patients were included in the study. Median CRP was significantly lower in HLH compared to AOSD (68.9 mg/L versus 168.0 mg/L, p &amp;lt; 0.001) and CCS (68.9 mg/L versus 121.0 mg/L, p = 0.024) (Figure 1). Median serum ferritin levels were significantly lower in CCS compared to HLH (1,386 ng/mL versus 16,722, p &amp;lt; 0.001) and AOSD (1,3860 ng/mL versus 12,480 ng/mL, p = 0.016). There was no significant difference in ferritin levels between HLH and AOSD. The ROC curve was performed for CRP values in total HLH cases which demonstrated an Area Under the Curve (AUC) of 0.799, indicating a fair diagnostic performance in differentiating HLH, with a sensitivity of 66.1% and specificity of 87.5% for CRP values less than 94.5 mg/L, as calculated by Youden's index. CONCLUSION CRP is significantly lower in HLH compared to AOSD and CCS, suggesting that mild to moderate elevations in CRP reflect the comparatively lower IL-6 activity underlying HLH. When used in conjunction with other inflammatory markers, especially marked hyperferritinemia, a comparatively lower CRP value helps capture the unique cytokine pattern underlying HLH, and is a useful, easily accessible biomarker than can aid in the diagnosis of HLH.

Alterations of Gut Microbiota Related with Status of Iron-Overload in Thalassemia Patients: A Cross-Sectional Pilot Study

Background: Gut dysbiosis can cause an impaired gut-barrier function and may contribute to the pathogenesis of various diseases. Iron overload is a common complication in thalassemia patients and can result in numerous complications, including those affecting the cardiovascular, endocrine, and immune systems. However, it is unclear how iron overload affects the gut microbiota of patients with thalassemia. Objective: To characterize the profiles of the gut microbiome in thalassemia patients compared with healthy participants, as well as to determine the association of these profiles with iron status. Method: Transfusion-dependent thalassemia (TDT) patients and healthy controls aged ≥ 18 years old were enrolled in the study. Stool samples were collected prior to receiving regular blood transfusions in the thalassemia group. Paired-end sequencing of 16s rRNA bacterial DNA extracted from each stool sample was performed. Serum ferritin levels were assessed in each participant to reflect iron status. Results: A total of 14 adult TDT patients and 14 healthy controls were enrolled, with a similar proportion of age and sex. The TDT patients had a significantly higher iron overload status than the controls (median serum ferritin level = 1424 in the TDT group and 197 in the control group; p &amp;lt; 0.001). The Shannon diversity index demonstrated a significant increase in gut microbial diversity in TDT patients as compared to healthy controls (7.06 vs. 6.48; p = 0.001). The TDT group showed a higher abundance of several gram-negative bacterial phyla, such as Bacteroidota, but a reduction in the abundance of Actinobacteriota as compared to the control group. Serum ferritin levels showed a positive correlation with higher gut diversity index. Conclusions: Our study suggests that TDT patients develop gut dysbiotic characteristics compared to the healthy population, with gut diversity associated with serum ferritin levels. This association suggests that iron overload induces gut dysbiosis.

Control variables of serum ferritin concentrations in hospitalized newborn infants: an observational study

Both iron excess and deficiency are deleterious to cellular and organ homeostasis. Serum ferritin levels serve as a biomarker of iron storage; however, their distribution and determinants in sick newborn infants remain unclear. This study aimed to investigate the reference range and independent variables of serum ferritin in hospitalized newborn infants. All newborn infants who were hospitalized at a tertiary neonatal center within 24 h of birth were retrospectively reviewed for the period of April 2015 through March 2017. Serum ferritin levels were assessed using venous blood samples obtained at admission and their independent variables were explored. The study population comprised 368 infants (36.2 ± 2.8 weeks gestation and 2319 ± 623 g at birth), whose median serum ferritin level was 149 µg/L (inter-quartile range: 81–236). The multivariable model used to explain serum ferritin values comprised hemoglobin, lactate dehydrogenase, blood pH, and maternal hypertensive disorders in pregnancy (all p < 0.01, adjusted for sex and birth weight). Serum ferritin values in hospitalized newborn infants were comparable to those previously reported using umbilical cord blood. Our novel findings indicated the association between blood pH, lactate dehydrogenase, and ferritin levels, suggesting the influence of antenatal hypoxia–ischemia and stress to serum ferritin levels.

Multisystem Inflammatory Syndrome in Children Associated with COVID-19 Infection: Clinical Presentation and Outcome

Abstract Objective In the midst of the COVID-19 pandemic, many children presenting with persistent fever, rashes, conjunctivitis, abdominal pain, respiratory distress, and shock were reported and diagnosed with multisystem inflammatory syndrome in children (MIS-C). The aim of the study was to observe the clinical presentation and outcome of MIS-C treated at a tertiary care hospital. Methods Eighteen children, aged 24 days to 18 years, with suspected MIS-C were admitted. Their clinical presentation, laboratory parameters, radiological investigations, management, and outcomes were recorded. Results Median age was 8 years (interquartile range [IQR]: 0.5, 14), and the male-to-female ratio was 1:1. Fever, tachycardia, respiratory distress, hypotension, and seizures with altered sensorium were present in 94.4, 88.8, 83.3, 44.4, and 44.4% of the cases, respectively. Median erythrocyte sedimentation rate, C-reactive protein, serum ferritin, and d-Dimer levels were 21 mm/h, 151 mg/L (1,14.2, 319), 1,091 µg/L (737.4, 1,456), and 3,094 ng/mL (990, 4,300), respectively. Methylprednisolone was given to all patients. Low molecular weight heparin and intravenous immunoglobulin (IVIG) were instituted in 83.3 and 38.8% cases, respectively. Seventeen patients (94.4%) required oxygen therapy and 44.4% needed mechanical ventilation. Fourteen patients (77.7%) recovered completely and four cases (22.2%) expired during the hospital stay. The need for ventilation and the presence of shock adversely affected the outcome. Conclusion Chief clinical presentations in the patients of MIS-C were fever, respiratory distress, hypotension, and altered sensorium. Among admitted patients, 87.8% cases were managed successfully by systemic corticosteroids with or without IVIG. Need for mechanical ventilation, shock, and central nervous system symptoms at admission appear to be important factors that can lead to mortality.

Drug-related problems among transfusion-dependent thalassemia patients: A real-world evidence study.

Introduction: Thalassemia is among the most common genetic disorders globally and many patients suffer from iron overload (IOL) complications that mainly affect the heart, liver and endocrine system. These events may be further complicated by drug-related problems (DRP), an inherent issue among patients with chronic diseases. Objective: The study aimed to evaluate the burden, associated factors and impacts of DRP in transfusion-dependent thalassemia (TDT) patients. Method: Eligible TDT patients under follow-up in a tertiary hospital between 01 March 2020 to 30 April 2021 were interviewed and their medical records were reviewed retrospectively to identify any DRP. DRPs were classified using the Pharmaceutical Care Network Europe (PCNE) classification version 9.1. The incidence and preventability of DRP were assessed and the associated risk factors were estimated by univariate and multivariate logistic regression. Results: A total of 200 patients were enrolled with a median (interquartile range: IQR) age of 28years at enrolment. Approximately 1 in 2 patients were observed to suffer from thalassemia-related complications. Throughout the study period, 308 DRPs were identified among 150 (75%) participants, with a median DRP per participant of 2.0 (IQR 1.0-3.0). Of the three DRP dimensions, treatment effectiveness was the most common DRP (55.8%) followed by treatment safety (39.6%) and other DRP (4.6%). The median serum ferritin level was statistically higher in patients with DRP compared with patients without DRP (3833.02 vs. 1104.98μg/L, p < 0.001). Three risk factors were found to be significantly associated with the presence of DRP. Patients with frequent blood transfusion, moderate to high Medication Complexity Index (MRCI) and of Malay ethnicity were associated with higher odds of having a DRP (AOR 4.09, 95% CI: 1.83, 9.15; AOR 4.50, 95% CI: 1.89, 10.75; and AOR 3.26, 95% CI: 1.43, 7.43, respectively). Conclusion: The prevalence of DRP was relatively high amongst TDT patients. Increased medication complexity, more severe form of the disease and Malay patients were more likely to experience DRP. Hence, more viable interventions targeted to these groups of patients should be undertaken to mitigate the risk of DRP and achieve better treatment outcomes.

Ferritin level predicts in-hospital mortality in hypertensive patients with COVID-19

Aim. This study aimed to establish the predictive ability of serum ferritin levels for severe / critical condition development, need for supplemental oxygen, and in-hospital mortality in hypertensive patients with COVID-19-associated pneumonia. Materials and methods. 135 unvaccinated patients hospitalized for COVID-19-associated pneumonia were enrolled in the study. 78.5 % of patients were hypertensive. Results. Among hypertensive patients, the median ferritin level at admission was 315.5 (169.0–396.0) ng/mL in patients with moderate condition, 374.0 (171.0–709.5) ng/mL in patients developed severe condition, and 489.0 (362.0–1128.5) ng/mL in patients developed critical condition (P = 0.03). Serum ferritin level at admission was higher in non-survivors (539.0 (440.0–1128.5) ng/mL) than that in survivors (332.5 (172.0–545.0) ng/mL, P = 0.02). Hypertensive patients who required supplemental oxygen had higher median serum ferritin level (446.0 (187.0–763.0) ng/mL) than patients without the requirement of supplemental oxygen (324.0 (165.0–401.0) ng/mL, P = 0.02). There was poor discrimination ability of ferritin level in the prediction of severe / critical conditions (AUC = 0.628, P = 0.02) and the need for supplemental oxygen (AUC = 0.629, P = 0.02). There was an acceptable discrimination ability of ferritin level in the in-hospital mortality prediction (AUC = 0.701, P = 0.03); the Youden index was 0.54, the associated criterion was &gt;438.0 ng/mL with 83.3 % sensitivity and 70.7 % specificity. Ferritin level &gt;438.0 ng/mL at admission was associated with a significant increase in in-hospital mortality (OR = 12.04 (2.47–58.62), P = 0.002). Conclusions. Serum ferritin level at hospital admission increases with the severity of COVID-19 in hypertensive patients. Serum ferritin level predicts in-hospital mortality in hypertensive patients. However, its predictive ability for the disease progression to severe/critical conditions and the need for supplemental oxygen is poor. A ferritin level of 438.0 ng/mL is proposed to be a cut-off value for the prediction of in-hospital mortality.

COVID-19 infection among vaccinated and unvaccinated: Does it make any difference?

There is a probability that vaccination may lead to reduction in the severity and complications associated with COVID-19 infection among hospitalized patients. This study aimed to determine the characteristics, clinical profiles, and outcomes of COVID-19 infection in vaccinated and non-vaccinated patients. This prospective observational cohort study was conducted at the Aga Khan University Hospital (AKUH) and recruited COVID-19 patients admitted between June 1st and September 30th, 2021. Patients' demographics, date of admission and discharge, comorbid conditions, immunization status for COVID-19 infection, presenting complaints, lab workup and computed tomography (CT) scan findings were obtained from the medical records. The primary outcome of the study was patients' condition at discharge and the secondary outcomes included level of care, length of stay (LOS), requirement of non-invasive ventilation (NIV) and inotropic support. Among a cohort of 434 patients, 37.7% (n = 164), 6.6% (n = 29) and 55.5% (n = 241) were fully vaccinated, partially vaccinated, and unvaccinated, respectively. Around 3% and 42.9% of the patient required inotropic and NIV support respectively; however, there was no discernible difference between them in terms of vaccination status. In case of unvaccinated patients there were significantly increased number of critical care admissions (p-value 0.043). Unvaccinated patients had significantly higher median serum procalcitonin, ferritin, LDH and D-dimer levels. Around 5.3% (n = 23) of the patient required invasive ventilation and it was more common in unvaccinated patients (p-value 0.04). Overall, mortality rate was 12.2% (n = 53) and this was higher (16.2%, n = 39) in unvaccinated patients as compared to fully vaccinated patients (6.1%, n = 10, p-value 0.006). Through this preliminary data, we can conclude that patient can develop severe and critical COVID-19 infection despite being vaccinated but this proportion is low as compared to unvaccinated population. So, uninterrupted endeavors need to be done to vaccinate as many individuals as possible. Furthermore, more effective vaccinations need to be developed to lessen the high death toll of COVID-19 infection.

Serum C-reactive Protein &amp; Ferritin Level in Patients with Maintenance Hemodialysis

Background: Hemodialysis is the widely used renal replacement therapy for end stage renal disease. Chronic inflammation isvery common in patients with maintenance hemodialysis. There are several markers to assess the inflammatory status. Some ofthese markers strongly predict the mortality &amp; morbidity among these patients. Objectives: This study was carried out to determine serum C-reactive protein and ferritin level inpatients with maintenancehemodialysis (MHD). Methods: This cross-sectional study was carried out in the Department of Biochemistry, Dhaka medical college, Dhaka fromthe period of July 2018 to June2019. In this study, thirty patients on MHD were taken from the dialysis unit,Department of Nephrology, Dhaka Medical College Hospital, Dhaka. For betterassessment another age and sex matched thirty healthyindividual were also taken.SerumCRP and ferritin level of all participants were measured and all values wereanalyzedstatistically. Results: Serum C-reactive protein level was found to be higher than normal in 70%of MHD patients. Median CRP level wassignificantlyhigher in hemodialysis group (13.9 mg/L) when compared with controls (1.74 mg/L). 80% MHD patient hadserum ferritin value &gt;500 μg/L. Median serum ferritin level was alsosignificantly higher in hemodialysis patients comparedwith controls (1342 μg/L vs 51 μg/L). Serum CRP had significant positivecorrelation with serum ferritin in high CRP group ofMHD patients (r= 0.658, p= 0.001). Conclusion: Serum CRP and ferritin level were higher in MHD patients than control. Serum CRP had linear positive relationwith serum ferritin in MHD patients having high CRP value.

Multiple Blood Transfusion may contribute to Abnormal Liver and Endocrine Functions in Adults with Sickle Cell Anaemia

Background: The study evaluated the effect of multiple blood transfusions on the prevalence of iron load and its effects on organ functions in patients with sickle cell anaemia (SCA).&#x0D; Methodology: Sixty-seven multiply transfused SCA subjects and 58 non-multiply transfused SCA controls were investigated. Serum ferritin, insulin, growth hormone (GH), thyroid stimulating hormone (TSH), triiodothyronine (T3) and thyroxine (T4) were measured by the ELISA method while plasma alanine transaminase (ALT) was measured spectrophotometrically.&#x0D; Results: The median serum ferritin level was 364.97 (142.5-579.3) ng/ml and that of ALT was 12.20 (7.4-16.7) IU/l in the subjects and were significantly higher compared with 115.31 (81.3-285.6) ng/ml and 7.74(5.9-9.9) IU/l obtained in the controls (p &lt;0.001 in each case). TSH was significantly lower 1.45 (0.4-2.9) µIU/ml in subjects compared with 2.12 (0.7-3.6) µIU/ml obtained in the controls (p = 0.034). The mean values for T4 in the subjects was 10.19 ± 1.5 µg/dl and was significantly higher compared with that of the controls of 9.57 ± 1.5 µg/dl (p = 0.026). However, there were no significant differences in the mean values of T3, GH and Insulin between the cases and the controls. There was a strong correlation between serum ferritin level and the number of units of blood transfused in the subjects (r = 0.575, p &lt; 0.001).&#x0D; Conclusion: The study found high serum ferritin level in multiply transfused SCA patients and which also correlated with the number of blood units transfused.&#x0D; Authors&#x0D; O A Adeyeye 1, L Salawu 1 2

Assessment of iron overload in a cohort of Sri Lankan patients with transfusion dependent beta thalassaemia and its correlation with pathogenic variants in HBB, HFE, SLC40A1, and TFR2 genes

BackgroundIron overload (IO) is a complication in transfusion dependent beta thalassaemia (TDT). Pathogenic variants in genes involving iron metabolism may confer increased risk of IO. The objective of this study was to determine the magnitude of the cardiac and hepatic IO and determine whether pathogenic variants in HFE, SLC40A1 and TFR2 genes increase the risk of IO in a cohort of TDT patients in Sri Lanka.Materials and MethodsFifty-seven (57) patients with TDT were recruited for this study. Serum ferritin was done once in 3 months for a period of one year in all. Those who were ≥ 8 years of age (40 patients) underwent T2* MRI of the liver and heart. Fifty-two (52) patients underwent next generation sequencing (NGS) to identify pathogenic variants in HBB, HFE, SLC40A1 and TFR2 genes.ResultsThe median age of the patients of this cohort was 10 years. It comprised of 30 (52.6%) boys and 27 (47.4%) girls. The median level of serum ferritin was 2452 ng/dl. Hepatic IO was seen in 37 (92.5%) patients and cardiac IO was seen in 17 (42.5%) patients. There was no statistically significant correlation between serum ferritin and hepatic or cardiac IO.Thirty-two (61.5%), 18 (34.6%), 2 (3.8%) of patients were homozygotes, compound heterozygotes and heterozygotes for pathogenic variants in the HBB gene. Eight (15.4%) and 1 (1.9%) patients were heterozygotes for pathogenic and likely pathogenic variants of HFE genes respectively. There were no pathogenic variants for the TfR2 and SLC40A1 genes. The heterozygotes of the pathogenic variants of the HFE were not at increased risk of IO.ConclusionsCardiac T2* MRI helps to detect cardiac IO in asymptomatic patients. It is important to perform hepatic and cardiac T2* MRI to detect IO in patients with TDT. There was no statistically significant correlation between pathogenic variants of HBB and HFE genes with hepatic and cardiac IO in this cohort of patients.

The Long-Term Efficacy of Deferiprone in Thalassemia Patients With Iron Overload: Real-World Data from the Registry Database

Deferiprone (DFP) is an oral iron-chelating agent that is widely used in thalassemia patients with iron overload. This study aimed to investigate the long-term efficacy of DFP monotherapy on serum ferritin (SF) and adverse events. All thalassemia patients aged 15 years or older who received DFP monotherapy were identified from the thalassemia registry database between November 2008 and October 2019. After treatment, patients who achieved a target SF level, defined as <1000.0 ng/mL in transfusion-dependent thalassemia (TDT) and <800.0 ng/mL in non-TDT (NTDT) for two consecutive visits, were categorized as the achievable group. We used multivariate analysis to identify factors that contribute to differences between groups. One hundred and five patients were enrolled in the study with a median age of 28 (19–41) years and median initial SF level of 1399.0 (1141.0–2169.0) ng/mL. Of these, 61.0% carried Hb E (HBB: c.79G>A)/β-thalassemia (β-thal) and 60.0% were TDT patients. The median DFP dose was 63 (47–73) mg/kg/d and the median follow-up duration of treatment was 36 (20–54) months. A total of 58 (55.24%) patients were in the achievable group. The initial SF level <1350.0 ng/mL was significantly associated with achieving a targeted SF level (p = 0.002). Ten adverse events resulted in withholding DFP. The most common was gastrointestinal irritation in four patients and three patients with agranulocytosis. In conclusion, DFP is an effective iron chelator in thalassemia patients. Slightly more than half the patients (55.0%) achieved a target SF level. Lower SF levels at the beginning were an important factor.