PURPOSE:Chronic red cell transfusion has been used for prevention of recurrent stroke in patients with sickle cell disease for three decades, and its effectiveness in primary prevention was recently shown. Iron overload, the inevitable result of chronic transfusion, is commonly monitored with serum ferritin concentration. PATIENTS AND METHODS: Sixty-one patients at high risk for stroke received chronic transfusion in a clinical trial of stroke prevention. A serum ferritin level of less than 500 ng/mL was required for study entry. Ferritin levels were obtained quarterly. Fifty patients who had four or more ferritin measurements were included in this analysis. Transfusions were administered as exchange or simple, with washed, reconstituted, or packed red blood cells, at the discretion of the site investigator. RESULTS:Serum ferritin levels increased linearly with cumulative transfusion volume during the first four ferritin measurements, but the rate of increase varied widely among patients. Rates of increase varied similarly among 23 patients who received exclusively simple transfusion with packed red cells and in five patients who received exchange transfusions. Thirty-two patients received a total transfusion volume of more than 250 mL/kg. Ferritin continued to increase linearly after the first four measurements in 14, but the remaining 18 experienced a plateau before the level reached 3,000 ng/mL. Six of those with a linear increase never reached a ferritin level of 3,000 ng/dL. CONCLUSIONS: There was strong intrapatient correlation between serum ferritin levels and volume transfused but wide interpatient variability early during chronic transfusion therapy. Intrapatient correlation declined at transfusion volumes of more than 250 mL/kg. Direct iron store assessment is needed to determine the clinical significance of serum ferritin variability.
RCT Entities:
PURPOSE: Chronic red cell transfusion has been used for prevention of recurrent stroke in patients with sickle cell disease for three decades, and its effectiveness in primary prevention was recently shown. Iron overload, the inevitable result of chronic transfusion, is commonly monitored with serum ferritin concentration. PATIENTS AND METHODS: Sixty-one patients at high risk for stroke received chronic transfusion in a clinical trial of stroke prevention. A serum ferritin level of less than 500 ng/mL was required for study entry. Ferritin levels were obtained quarterly. Fifty patients who had four or more ferritin measurements were included in this analysis. Transfusions were administered as exchange or simple, with washed, reconstituted, or packed red blood cells, at the discretion of the site investigator. RESULTS: Serum ferritin levels increased linearly with cumulative transfusion volume during the first four ferritin measurements, but the rate of increase varied widely among patients. Rates of increase varied similarly among 23 patients who received exclusively simple transfusion with packed red cells and in five patients who received exchange transfusions. Thirty-two patients received a total transfusion volume of more than 250 mL/kg. Ferritin continued to increase linearly after the first four measurements in 14, but the remaining 18 experienced a plateau before the level reached 3,000 ng/mL. Six of those with a linear increase never reached a ferritin level of 3,000 ng/dL. CONCLUSIONS: There was strong intrapatient correlation between serum ferritin levels and volume transfused but wide interpatient variability early during chronic transfusion therapy. Intrapatient correlation declined at transfusion volumes of more than 250 mL/kg. Direct iron store assessment is needed to determine the clinical significance of serum ferritin variability.
Authors: Elizabeth S Klings; Roberto F Machado; Robyn J Barst; Claudia R Morris; Kamal K Mubarak; Victor R Gordeuk; Gregory J Kato; Kenneth I Ataga; J Simon Gibbs; Oswaldo Castro; Erika B Rosenzweig; Namita Sood; Lewis Hsu; Kevin C Wilson; Marilyn J Telen; Laura M Decastro; Lakshmanan Krishnamurti; Martin H Steinberg; David B Badesch; Mark T Gladwin Journal: Am J Respir Crit Care Med Date: 2014-03-15 Impact factor: 21.405
Authors: Soo Jin Bae; Christine Kang; Ki Woong Sung; Hee Won Chueh; Meong Hi Son; Soo Hyun Lee; Keon Hee Yoo; Hong Hoe Koo Journal: J Korean Med Sci Date: 2012-03-21 Impact factor: 2.153
Authors: Thomas V Adamkiewicz; Miguel R Abboud; Carole Paley; Nancy Olivieri; Melanie Kirby-Allen; Elliott Vichinsky; James F Casella; Ofelia A Alvarez; Julio C Barredo; Margaret T Lee; Rathi V Iyer; Abdullah Kutlar; Kathleen M McKie; Virgil McKie; Nadine Odo; Beatrice Gee; Janet L Kwiatkowski; Gerald M Woods; Thomas Coates; Winfred Wang; Robert J Adams Journal: Blood Date: 2009-08-31 Impact factor: 22.113