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Published on: March 14, 2017
Relationship between serum ferritin and growth status of pediatric transfusion dependent thalassemia
Andi Cahyadi1, I Dewa Gede Ugrasena1, Mia Ratwita Andarsini1
1Department of Child Health, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia.
Insights
Growth retardation in pediatric transfusion-dependent thalassemia (TDT) is linked to high ferritin levels and specific iron chelation treatments. Upper body segment shortening and height were most affected, highlighting the need for optimized TDT management.
Area of Science:
- Pediatric Hematology
- Endocrinology
- Growth and Development
Background:
- Growth retardation, characterized by short stature and upper body segment shortening, is a significant long-term complication in pediatric transfusion-dependent thalassemias (TDTs).
- This condition arises from multifactorial causes including chronic hypoxia, iron overload, endocrinopathy, inadequate transfusions, and iron chelation therapy.
- Understanding the impact of iron overload on growth is crucial for managing TDT patients.
Purpose of the Study:
- To analyze the relationship between serum ferritin levels and various growth parameters in pediatric patients with TDT.
- To compare the growth status of TDT patients undergoing different iron chelation regimens.
Main Methods:
- A cross-sectional study involving pediatric TDT patients aged 2-18 years was conducted.
- Growth parameters including upper/lower body segment ratio, weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ), and BMI Z-score were assessed using CDC growth charts.
- Serum ferritin levels were monitored, and statistical analyses (Spearman correlation, Mann-Whitney U test) were performed to evaluate associations.
Main Results:
- Serum ferritin showed a significant negative correlation with the upper/lower body segment ratio (rho=-0.552; P=0.002), but not with HAZ, WAZ, or BMI Z-score.
- Growth retardation was more pronounced in patients with serum ferritin levels exceeding 2500 µ/L.
- Patients treated with deferiprone exhibited lower WAZ and BMI Z-scores and a greater upper/lower body segment ratio compared to those on deferasirox.
Conclusions:
- High ferritin levels and deferiprone treatment are associated with more pronounced growth retardation in pediatric TDT.
- Height and the upper/lower body segment ratio are particularly affected growth parameters in this population.
- These findings underscore the importance of vigilant monitoring of iron levels and consideration of chelation strategies in managing growth in pediatric TDT.
Background:
Growth retardation is a long-term complication in pediatric transfusion-dependent thalassemias (TDTs), presented as short-stature and upper body segment shortening. The cause of this condition was chronic hypoxia, iron overload, endocrinopathy, inadequate transfusion, and iron chelation. We analyze the relationship between ferritin level and growth status of pediatric TDTs.
Methods:
This was a cross-sectional study on pediatric TDTs aged 2-18 years old at Dr. Soetomo General Academic Hospital Surabaya, Indonesia conducted in 2020. They required blood transfusion every 2-4 weeks. We evaluated the ratio of upper/lower body segments, weight for age Z-score (WAZ), height for age Z-score (HAZ), and body mass index (BMI) Z-score, based on CDC growth chart as growth status parameters. Serum ferritin was checked every three months to determine iron overload and iron chelation (deferiprone, deferasirox and deferoxamine). We used Spearman correlation and Mann-Whitney U test to analyze between variables (α=0.05).
Results:
We enrolled 15/29 males with median age 10.5 years. Serum Ferritin had negative correlation with the ratio of upper/lower body segments (rho=-0.552; P=0.002), but not for HAZ (rho=-0.078; P=0.694), WAZ (rho=-0.186; P=0.342), BMI Z-score (rho=-0.089; P=0.653) especially if serum ferritin was above 2500 µ/L. In deferiprone group (n=8), the WAZ (P=0.034) and BMI Z-score (P=0.031) were lower; but the ratio of upper/lower body segments was greater (P=0.039) than the deferasirox group.
Conclusion:
Growth retardation was more visible in pediatric TDTs with high ferritin and in deferiprone group. The height and the ratio of upper/lower body segments of the body were more affected.
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