ISSN No. 2079-8547 (Recognized by PMDC)
SERIAL SERUM FERRITIN LEVELS FOR MONITORING RESPONSE TO IRON CHELATION THERAPY IN PATIENTS OF BETA THALASSAEMIA MAJOR “PROSPECTIVE COHORT STUDY
Abstract
Background: In Beta Thalassaemia Major repeated blood transfusion, ineffective erythropoiesis and increased gastrointestinal
iron absorption lead to iron overload in the body. The management of the iron overload in these patients
requires the administration of iron chelators continuously and evaluation of serum ferritin levels at regular intervals.
Aims & Objective: The aim of this study is to analyze serum ferritin level among Beta Thalassaemia Major patients
and to see the effect of iron chelation therapy in transfusion dependent thalassemic patients.
Study Design: Prospective cohort study.
Study Setting & Duration: Seven (7) months from January to July 2014 at Hematology Day Care Center HMC Peshawar
Pakistan.
Subjects & Methods: A total of 50 thalassemia major patients were selected and their blood samples were evaluated
for serum ferritin assays by electrochemiluminescenc immunoassay technology (ECLIA) on cobas e 411 Roche special
immunoassay analyzer. 3ml of venous blood was collected in a BD disposable syringe which was then transferred to
serum vacutainer for estimation of serum ferritin levels. Serum ferritin assays were done on Day 0, then after 3 months
& then after another 3 months of iron chelation therapy.
Results: The mean pre-Iron chelation therapy with desferoxamine (DFO) & Deferasirox (Asunra®) of serum ferritin was
3465.97 ng/ml ± std 2120.097 ng/ml and mean serum ferritin levels after 3 months & 6 months iron chelation was
2984.96 ng/ml ± std 1979.837 ng/ml and 2455.44 ng/ml ± std 1816.722 ng/ml respectively.
A highly significant difference (P <0.01) was observed between the two i.e. 0 day & 3 months serum ferritin levels.
Similarly highly significant difference (P < 0.01) was also seen at 3 months & 6 months intervals.
Conclusion: Serum ferritin is used for efficacy monitoring of iron chelation therapy and is a suitable method for ascertaining
the iron metabolism situation. Determination of ferritin at the beginning of therapy provides a representative
measure of the body iron reserves. Single or sporadic measurement of serum ferritin alone is a poor indicator of iron
burden in the transfusion dependent patients like beta thalassemia major. Nevertheless serial studies in individual
patients usually give an indication of whether the iron burden in that patient is static, increasing or decreasing . In
addition the maintenance of serum ferritin level below 2500 μg/L is associated with improved survival free of cardiac
disease in patients with thalassemia.
Key Words: Beta Thalassaemia Major, Ferritin, Iron Chelators, Iron overload.