Introduction: Packed red blood cell (PRBC) transfusions are an essential component of leukemia treatment regimens. Transfusion-induced iron overload can be seen after approximately 10 to 20 transfusions. Very little is known about transfusion-related iron burden in oncology populations and its possible effect on endocrine function and glycemia.
Patients and methods: We evaluated growth parameters and endocrine disorders in relation to the iron overload status measured by serum ferritin concentration and the quantity of liver iron (LIC) measured by the Ferriscan method in 7 adolescents aged 16±1.5 years treated with conventional chemotherapy for acute lymphocytic leukemia (ALL) between 2 and 4 years post diagnosis, who received more than 10 packed red cells transfusions (PCT) during their treatment. Anthropometric measurements were recorded and height SDS and BMI were calculated. Lab investigations included measuring hepatic enzymes (ALT, AST, and ALP), fasting blood glucose (FBG) and thyroid function (free T4 and TSH).
Results: The mean HtSDS of patients=−1.25±0.53, and their mean BMI=24±5.2 kg/m2. None had HtSDS <−2 and 1 had BMI >30 (Obese). They all had normal hepatic enzyme concentrations (ALT, AST and ALP) and renal function. Their mean serum ferritin=853±480 μg/l and their LIC ranged between 1.2 and 5.6 mg Fe/g dry liver (mild iron liver iron overload). All had normal FT4 and TSH levels. 1 had diabetes (BMI=24, FBG=7.4 mmol/l, ferritin level=1600 μg/l and LIC=3.3 mg Fe/g dry liver) and another one had impaired fasting glucose (BMI=20.4, FBG=6.5 mmol/l, ferritin level 1250 μg/l and LIC=3.4 mg Fe/g dry liver).
Conclusion: Adolescent survivors of childhood ALL with a history of repeated PCT and serum ferritin >1000 μg/l had a higher risk for developing glycemic abnormalities and they may need iron chelation and follow up of their glycemic status.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology