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Pancreatic iron in pediatric transfusion-dependent beta-thalassemia patients: A longitudinal MRI study
Antonella Meloni1,2, Laura Pistoia2,3, Maria Caterina Putti4
1Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.
Insights
Pancreatic siderosis is common in children with transfusion-dependent thalassemia (TDT), linked to liver and heart iron overload and glucose issues. Iron removal from the pancreas is difficult in TDT patients.
Area of Science:
- Pediatric Hematology
- Medical Imaging
- Endocrinology
Background:
- Pediatric patients with transfusion-dependent thalassemia (TDT) often experience iron overload (IO).
- Pancreatic siderosis, or iron accumulation in the pancreas, is a potential complication of IO.
- Understanding the prevalence and clinical impact of pancreatic siderosis in TDT is crucial.
Purpose of the Study:
- To evaluate the prevalence, pattern, and clinical associations of pancreatic siderosis in pediatric TDT patients.
- To assess changes in pancreatic iron levels and their relationship with total body iron balance.
- To investigate the link between pancreatic siderosis, hepatic siderosis, myocardial siderosis, and glucose metabolism.
Main Methods:
- Eighty-six pediatric TDT patients were enrolled.
- Iron overload was quantified using R2* magnetic resonance imaging (MRI).
- Pancreatic and cardiac iron levels, liver iron concentration, and glucose metabolism were assessed.
Main Results:
- Seventy-three percent of patients exhibited pancreatic IO (R2* > 38 Hz).
- Pancreatic IO correlated significantly with serum ferritin, liver iron concentration, and cardiac IO.
- Pancreatic IO was associated with altered glucose metabolism; iron removal from the pancreas proved challenging.
Conclusions:
- Pancreatic siderosis is frequent in pediatric TDT, associated with hepatic siderosis and a risk factor for myocardial siderosis and glucose metabolism alterations.
- Iron removal from the pancreas is exceptionally challenging in TDT patients.
- Pancreatic iron status is independent of hepatic iron status.
Background:
In pediatric transfusion-dependent thalassemia (TDT) patients, we evaluated the prevalence, pattern, and clinical associations of pancreatic siderosis and the changes in pancreatic iron levels and their association with baseline and changes in total body iron balance.
Procedure:
We considered 86 pediatric TDT patients consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network. Iron overload (IO) was quantified by R2* magnetic resonance imaging (MRI).
Results:
Sixty-three (73%) patients had pancreatic IO (R2* > 38 Hz). Global pancreas R2* values were significantly correlated with mean serum ferritin levels, MRI liver iron concentration (LIC) values, and global heart R2* values. Global pancreas R2* values were significantly higher in patients with altered versus normal glucose metabolism. Thirty-one patients also performed the follow-up MRI at 18 ± 3 months. Higher pancreatic R2* values were detected at the follow-up, but the difference versus the baseline MRI was not significant. The 20% of patients with baseline pancreatic IO showed no pancreatic IO at the follow-up. The 46% of patients without baseline pancreatic IO developed pancreatic siderosis. The changes in global pancreas R2* between the two MRIs were not correlated with baseline serum ferritin levels, baseline, final, and changes in MRI LIC values, or baseline pancreatic iron levels.
Conclusions:
In children with TDT, pancreatic siderosis is a frequent finding associated with hepatic siderosis and represents a risk factor for myocardial siderosis and alterations of glucose metabolism. Iron removal from the pancreas is exceptionally challenging and independent from hepatic iron status.
