The correlation between serum ferritin levels and impaired heart function in children with transfusion dependent thalassemia

Carrina Nenggar  Dewanti; I Ketut Alit  Utamayasa; IDG  Ugrasena

doi:10.30574/gscbps.2021.16.2.0239

Authors

Carrina Nenggar Dewanti Department of Child Health, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Surabaya, Indonesia.
I Ketut Alit Utamayasa Department of Child Health, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Surabaya, Indonesia.
IDG Ugrasena Department of Child Health, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Surabaya, Indonesia.

DOI:

https://doi.org/10.30574/gscbps.2021.16.2.0239

Keywords:

Transfusion Dependent Thalassemia, Impaired Heart Function, Serum Ferritin, TAPSE, E/A ratio

Abstract

Background: Paediatric patients with transfusion dependent thalassemia require regular lifelong red cell transfusions. Blood transfusions increase the risk of iron overload, which can lead to cardiac hemosiderosis. Serum ferritin can be a parameter for evaluating systemic hemosiderosis.

Objective: To evaluate the correlation between serum ferritin levels and impaired heart function in children with transfusion dependent thalassemia

Methods: A cross sectional study was conducted with transfusion-dependent thalassemia who attended a cardiology and hemato-oncology outpatient clinic from January to December 2018 and had undergone more than 10 transfusion periods. Serum ferritin levels were taken from the mean of 3 measurements before echocardiography. Echocardiography examination was performed by a cardiologist using a 3D Doppler tool to evaluate ejection fraction (EF), tricuspid annular plane systolic excursion (TAPSE) and E / A ratio by calculating the initial diastole (E wave) and atrial contraction (wave A). Data analysis used the Spearman correlation with p <0.05.

Results: There were 45 children with a median age of 10 (2-17) years and had received a median of 18 (10-51) blood transfusions. The mean serum ferritin level was 4,321 (1,168-15,233) ng / mL. Blood transfusion frequency was associated with an increase in serum ferritin (rho 0.74, P <0.005). From echocardiography examination, approximately 3/45 children had a feature of dilated cardiomyopathy. The mean value of EF 70 (SD 14.32), TAPSE 1.97 (SD 0.57) cm and an E / A ratio 1.68 (SD 0.46). Serum ferritin was negatively correlated with the ejection fraction (rho = -0.78, P <0.001), TAPSE (rho = -0.65, P <0.001) but positively correlated with the E / A ratio (rho = 0.67, P <0.001).

Conclusion: Paediatric patients with TDT have decreased cardiac systolic and diastolic function, and serum ferritin correlates with the decreased cardiac function.

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