Serum ferritin level in adult sickle cell anemia in Saudi population

Ahmed M Alsuliman; Mahmoud Albagshi; Kefah B Algadeeb; Abdulmottaleb Aldanden; Abbas I Alabdultif

doi:10.4103/1658-5127.146949

ORIGINAL ARTICLE

Year : 2014 | Volume : 5 | Issue : 4 | Page : 148-150

Serum ferritin level in adult sickle cell anemia in Saudi population

Ahmed M Alsuliman, Mahmoud Albagshi, Kefah B Algadeeb, Abdulmottaleb Aldanden, Abbas I Alabdultif
Department of Medicine, Hematology Section, King Fahad Hospital, Hofuf, Saudi Arabia

Date of Web Publication

13-Dec-2014

Correspondence Address:
Ahmed M Alsuliman
Department of Medicine, King Fahad Hospital
Saudi Arabia

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/1658-5127.146949

Abstract

Background: Vaso-occlusive and hemolysis are the clinical hallmarks of sickle cell disease .patients with sickle cell at risk of iron overload due to chronic blood transfusion treating complications of the disease ,in addition to increasing iron absorption from gut and chronic hemolysis. Material and Methods: This is retrospective study on total of 174 adult sickle cell disease patients were included in this study, attending hematology clinic in king Fahad Hofuf hospital and inherited blood disorder center-Alhassa. for each patient demographic data was obtained (age, sex, nationality), history of previous blood transfusion, hemoglobin level, serum ferritin level. In total, 174 naïve Saudi adult patients (113 males, 61 females) were included in this study. Mean age was 28.2 ±10 years (range 12- 62 years), sex ratio (M/F) was 1.8 :1.0 . 93 (53%) patients had history of previous blood transfusion. The overall mean serum ferritin concentration was 587 ± 547(18.49 - 2660 ng\dl). The mean serum ferritin level for male is 649 ± 606 ng\dl and mean serum ferritin level for female is 473± 440ng\dl. Conclusion: Iron overload in sickle cell disease patients from eastern province remains mild to moderate, with significant sex difference. The repetitive assessment of serum ferritin level should be consider to sickle cell patients whom frequent blood transfusion is needed like stroke and renal failure.

Keywords: Ferritin, red blood cells, sickle cell

How to cite this article:
Alsuliman AM, Albagshi M, Algadeeb KB, Aldanden A, Alabdultif AI. Serum ferritin level in adult sickle cell anemia in Saudi population. J Appl Hematol 2014;5:148-50

How to cite this URL:
Alsuliman AM, Albagshi M, Algadeeb KB, Aldanden A, Alabdultif AI. Serum ferritin level in adult sickle cell anemia in Saudi population. J Appl Hematol [serial online] 2014 [cited 2023 Sep 30];5:148-50. Available from: https://www.jahjournal.org/text.asp?2014/5/4/148/146949

Introduction

Vaso-occlusive and hemolysis are the clinical hallmarks of sickle cell disease (SCD). Patients with sickle cell at risk of iron overload due to chronic blood transfusion are treating complications of the disease, in addition to increasing iron absorption from gut and chronic hemolysis. ^{[1],[2],[3],[4]}

Ferritin is the primary iron storage protein in tissues; it is also an acute phase reactant with elevated serum levels in the presence of chronic inflammation, infection, and liver disorders associated with SCD in crisis. ^[5],[6],[7]

In this study, we examined the extent of iron overload and the predictive value of ferritin in estimating iron overload in adult with SCD.

Materials and Methods

In this retrospective study, the total of 174 adult SCD patients were included, attending hematology clinic for each patient demographic data (age, sex, nationality), and history of previous blood transfusion, hemoglobin (Hb) level, alanine aminotransferase (ALT), aspartate aminotransferase (AST) alkaline phosphates bilirubin level, hepatitis B and C, serum ferritin level were obtained. Including criteria were adult patients (age ≥ 12 years) in their usual state of health with no admission for 1-month serum ferritin values measure by immunoenzyme and normal range is adult males (17-323 ug/L) adult females (7-283 ug/L) data were analyzed using Chi-square analysis, and P < 0.05 were consider to be as significant.

Results

A total of 174 naïve Saudi adult patients (113 males, 61 females) were included in this study. The mean age was 28.2 ± 10 years (range: 12-62 years), sex ratio (male/female) was 1.8:1.0 [Table 1]. About 93 (53%) patients had a history of previous blood transfusion during their course, but no one of them was in chronic blood transfusion program.

Table 1: Distribution age\sex

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The overall mean serum ferritin concentration was 587 ± 547 (18.49-2660 ng\dl). The mean serum ferritin level for male is 649 ± 606 ng\dl, and mean serum ferritin level for female is 473 ± 440 ng\dl.

Moreover, 10 of our patients are positive for the hepatitis marker, with mean serum ferritin level of 549.1 ± 462.7 (176-1118 ng\dl). ALT mean 41 ± 33.3, AST 35.7 ± 31.2. No one of patients had received iron chelating therapy.

Discussion

This study evaluates the magnitude of iron overload in SCD patients in the eastern province of Saudi Arabia. This study shows that mean serum ferritin levels of 174 patients with SCD is 587 ± 547 ng\dl (18.49-2660 ng\dl), with significant differences between both sex as male has higher mean serum ferritin as compared to female (male 649 ± 606 ng\dl, female 473 ± 440 ng\dl) [Table 2].

Table 2: Serum ferritin level related to sex

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Majority (80%) of patients have serum ferritin level < 1000 ng\dl [Table 3] with no serious health problems related to iron overload comparing to patients with B-thalassemia major. Many studies showed behavior of iron overload SCD comparing to thalassemia major is different and suggest SCD patients are relatively protected from iron-induced cardiac and endocrine organ damage. ^{[8],[9],[10],[11],[12]} In fact, one study report one possible mechanism of protection of patient with SCD increase iron elimination rates through renal system. ^[13]

Table 3: Distribution of serum ferritin

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Classically, serum ferritin has been used to monitor patient with high serum ferritin and to less extent liver biopsy. So high serum ferritin concentration need to be deal cautiously in SCD patients with no history of chronic blood transfusion, as serum ferritin can be elevated in different medical conditions (fever, acute painful crisis, infection, inflammation, and hepatic dysfunction). Recently, magnetic resonance imaging has proven effectively in detecting and quantifying iron deposition in liver and heart. ^{[14],[15],[16],[17],[18],[19]}

Iron overload is toxic to many tissues, particularly the heart and endocrine system. About 53% of our patients had history of blood transfusion for complication events or surgical indication, but not reaching to intensity of β - thalassemia major blood transfusion.it is known SCD - patients in Eastern part of Saudi Arabia maintaining high level of Hb at steady - state, milder disease phenotype comparing to African subtype due to genetic factors including alpha-thalassemia and high levels of fetal Hb, so there are not routinely transfused except for acute complications or stroke and renal failure. ^{[20],[21],[22],[23]}

Lower mean serum ferritin level in Female was reported in different studies. It may contribute to dietary deficiency, blood loss with the menstrual cycle, multi pregnancy, uterine dysfunction in female. ^{[24],[25],[26],[27],[28],[29]}

There is one study came from AL-Hassa area of Saudi Arabia supporting gender differences in acute pain, and showed that female do better than male in acute SCD pain crisis and these gender differences were not explained in that study. ^[30],[31]

Sickle cell disease patients are suffering from frequent painful crises; several studies showed iron depletion or less iron in the body is better by decreasing episode of painful crises and hemolysis. These studies suggested the mechanism of this effect is probably multifactorial: (a) The concentration of Hb level is known to influence the blood viscosity and its decrease always improved rheology in SCD patients; (b) the mean corpuscular Hb concentration is a critical factor concerning the HbS molecule polymerization in SCD, and its slight reduction may have an important biological effect. Prospective controlled studies are needed to evaluate further this observation. ^{[32],[33],[34],[35],[36],[37],[38]}

Conclusion

Iron overload in SCD patients from the eastern province remains mild to moderate, with significant sex difference. The repetitive assessment of serum ferritin level should be considered to sickle cell patients whom frequent blood transfusion is needed like stroke and renal failure.

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