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Understanding increased ferritin levels in pediatric ECMO patients

Zachary Weber1, Ashley Sam1, Alejandra Pena2

  • 1Brooke Army Medical Center, Fort Sam Houston, TX, USA.

Blood Cells, Molecules & Diseases
|October 17, 2021
PubMed

Insights

Serum ferritin is not a reliable indicator of iron overload in pediatric patients undergoing extracorporeal membrane oxygenation (ECMO). Ferritin levels are influenced by inflammation and erythropoiesis, not solely by iron levels.

Area of Science:

  • Biochemistry
  • Pediatric Critical Care
  • Hematology

Background:

  • Elevated serum ferritin is observed in pediatric patients during extracorporeal membrane oxygenation (ECMO).
  • Ferritin is often linked to iron overload due to frequent red blood cell transfusions in ECMO patients.
  • However, ferritin also acts as an acute-phase reactant, complicating its diagnostic utility for iron overload.

Purpose of the Study:

  • To evaluate the effectiveness of serum ferritin as a biomarker for diagnosing iron overload in pediatric ECMO patients.
  • To explore the relationship between ferritin levels, inflammation, and erythropoiesis during ECMO.
  • To investigate the role of erythropoietin (EPO) in this context.

Main Methods:

  • Analysis of serum ferritin, serum iron, interleukin-6 (IL-6), and erythropoietin (EPO) levels in pediatric ECMO patients.
  • Correlation analysis to assess relationships between these biomarkers.
  • Comparison of ferritin levels with iron status and inflammatory markers.

Main Results:

  • Ferritin was elevated in all pediatric ECMO cases (median 459 ng/ml).
  • Serum iron levels showed intermittent elevations but normalized before ECMO cessation.
  • Ferritin demonstrated a weak correlation with serum iron (r=0.05, p=0.65) but strong correlations with IL-6 (r=0.48, p<0.001) and EPO (r=0.55, p<0.001).
  • Erythropoietin levels remained high throughout ECMO despite transfusions and hyperoxia.

Conclusions:

  • Serum ferritin is an unreliable biomarker for diagnosing iron overload in pediatric ECMO patients.
  • Ferritin levels during ECMO are significantly influenced by inflammatory markers like IL-6 and erythropoiesis markers like EPO.
  • Further research is needed to understand the complex interplay between ferritin, EPO, and iron metabolism in ECMO patients.

Keywords:
Erythropoietin (EPO)Extracorporeal membrane oxygenation (ECMO)FerritinInflammationIron

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