Serum ferritin concentration in sickle cell crisis

Area of Science:

• Hematology
• Clinical Chemistry

Background:

• Sickle cell disease (SCD) is a genetic blood disorder characterized by vaso-occlusive crises.
• Serum ferritin levels are typically used to assess iron status, but their behavior during SCD crises is not well understood.

Purpose of the Study:

• To investigate the behavior of serum ferritin and liver enzymes during vaso-occlusive crises in adults with sickle cell disease.
• To determine if serum ferritin can be used as a marker for iron balance or disease severity during SCD crises.

Main Methods:

• Serum samples were collected from 12 adults with sickle cell disease (11 SS, 1 S beta degrees) during 21 vaso-occlusive crises and compared to steady-state values.
• Measured biomarkers included serum ferritin, aspartate aminotransferase (AST), alkaline phosphatase, and hydroxybutyrate dehydrogenase (HBD).
• Patients were categorized into untransfused, occasionally transfused, and multiply transfused groups.

Main Results:

• Serum ferritin concentrations increased in all patients during all crises, irrespective of transfusion history.
• Elevations in AST, alkaline phosphatase, and HBD were observed, but no correlation was found with log ferritin concentrations.
• The degree of ferritin rise appeared related to the clinical severity of the crisis, not directly to hemolysis or liver damage.

Conclusions:

• Serum ferritin levels rise significantly during sickle cell disease crises, potentially serving as a marker for the extent of vaso-occlusion and tissue damage.
• Serum ferritin is unreliable for assessing iron balance in sickle cell disease patients unless they are in a steady state.
• Hemolysis and liver damage are not the direct cause of the observed rise in serum ferritin during crises.