Background: Thalassemia major, one of the most common genetic diseases worldwide, causes severe anemia early in life. Routine blood transfusions, the main treatment, are a cause of severe morbidity and mortality, due to systemic iron accumulation, most importantly in the heart and liver. Both serum ferritin and T2* MRI sequences can be used to assess iron overload.
Purpose: The aim of this study was to assess the correlation between cardiac and hepatic T2* values and serum ferritin levels in thalassemia major patients as a function of liver disease severity.
Materials and Methods: The study cohort included 43 thalassemia major patients, treated at the Hadassah hospitals, and having at least one cardiac and hepatic T2* MRI. Average cardiac and liver T2* values were retrospectively calculated for each patient. Severity of liver disease was estimated by clinical rating system – MELD score. Laboratory data retrieved from Hadassah medical records included ferritin levels, serum hemoglobin, liver enzymes (ALT, AST, AP) and viral status (HBV, HCV).
Results: Pearson correlation coefficients of serum ferritin, ALT and AST values for liver and cardiac T2* were as follows: ferritin -0.264 (P=0.091) and -0.448 (p=0.003) respectively, ALT -0.279 (p=0.074) and -0.415 (p=0.006) respectively, and AST -0.085 (p=0.615) and -0.318 (p=0.055) respectively. Multivariate linear regression model showed a significant independent association only between serum ferritin and cardiac T2* values (β=-0.355, p=0.034). However, in a sub-group of 9 patients with significant liver disease (MELD score 10-19) Pearson correlation coefficient of serum ferritin for cardiac T2* values was 0.143 (p=0.714).
Conclusion: Serum ferritin levels appear to be a reliable marker for cardiac iron deposition patients with thalassemia major. However, in a subgroup of patients with significant liver disease serum ferritin seems to be less reliable.
