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Risk factors for hyperferritinemia secondary to red blood cell transfusions in pediatric cancer patients
Ali Amid1, Nick Barrowman, Abi Vijenthira
1Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada. aamid@cheo.on.ca
Insights
Pediatric cancer patients receiving transfusions are at risk of hyperferritinemia. Total transfused volume and body surface area changes are key predictors of this condition.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Packed red blood cell transfusions are frequently administered to pediatric cancer patients undergoing chemotherapy.
- Hyperferritinemia is a potential complication of frequent transfusions in this vulnerable population.
Purpose of the Study:
- To identify risk factors associated with hyperferritinemia in pediatric cancer patients who receive frequent blood transfusions.
- To determine characteristics that predict elevated ferritin levels secondary to transfusions.
Main Methods:
- Retrospective chart review of pediatric cancer patients who completed chemotherapy between January 2007 and January 2012.
- Analysis of variables including age, cancer type, weight, body surface area (BSA), number and volume of transfusions, and changes in weight and BSA from diagnosis to ferritin assessment.
Main Results:
- Of 109 patients, 85% received transfusions; 14.7% had ferritin levels >200 µg/L and 3.7% had levels >1,000 µg/L.
- Independent risk factors for hyperferritinemia were total transfused volume (TTV) and change in body surface area (BSA) from diagnosis to follow-up.
- Increased BSA correlated with reduced hyperferritinemia in follow-up measurements.
Conclusions:
- Total transfused volume (TTV) and changes in body surface area (BSA) are independent predictors of hyperferritinemia severity and persistence in pediatric cancer patients.
- These factors should be considered when planning interventions for managing hyperferritinemia.
Background:
Transfusion of packed red blood cells is common in pediatric cancer patients who receive chemotherapy. This study was done to identify characteristics of pediatric cancer patients at risk of hyperferritinemia secondary to frequent transfusions.
Procedure:
In this retrospective chart review, all pediatric cancer patients who completed chemotherapy from January 2007 to January 2012 and had an assessment of serum ferritin 6 months after the end of treatment were included. Variables included: age, sex, type of cancer diagnosis, weight and body surface area (BSA) at the time of diagnosis, number of transfusions, total transfused volume (TTV), total transfused volume per body weight (TVPBW), and weight and BSA change from the time of diagnosis to the time of ferritin check.
Results:
Of 109 eligible patients, 85 (78%) received transfusions. Sixteen patients (14.7%) had ferritin levels > 200 µg/L and four (3.7%) had ferritin levels > 1,000 µg/L. Although age, weight and BSA at cancer diagnosis, number of transfusions and TVPBW were correlated with the level of ferritin, independent risk factors were TTV (range 1,961-30,090 ml in patients with hyperferritinemia, P < 0.001) and BSA change from the time of diagnosis to the time of ferritin check (range -0.15 to 0.31 m(2) in patients with hyperferritinemia, P < 0.001). Increase in BSA was correlated with reduction of hyperferritinemia in follow-up ferritin measurements (P = 0.049).
Conclusions:
In addition to TTV, change in BSA is an independent predictor for the degree and possibly persistence of hyperferritinemia in pediatric cancer patients and should be considered in decisions to initiate interventions.
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