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Evaluation of Iron Overload in the Heart and Liver Tissue by Magnetic Resonance Imaging and its Relation to Serum Ferritin and Hepcidin Concentrations in Patients with Thalassemia Syndromes

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Abstract

Iron overload is one of the major prognostic factor in thallassemia patients. We aimed to evaluate iron accumulation in the heart and liver by MRI in thalassemia major, thalassemia intermedia, and S-ß thalassemia patients and to examine its association with ferritin and hepcidin levels. Serum ferritin and hepcidin levels were recorded. Iron overload (IOL) in the heart and liver parenchyma was determined based on the standardized T2* and R2 values measured by MRI. The results were evaluated considering the tissue iron overload, serum ferritin and hepcidin levels. Comparing the 109 patients with the 30 healthy controls revealed the mean age: 24.4 ± 11 versus 31.2 ± 5 years, median levels of serum ferritin: 1693 versus 40 ng/mL, and hepcidin: 1.94 versus 0.355 ng/mL; p < 0.001, respectively. Comparison of age, serum ferritin and hepcidin levels and MRI findings of the patients with or without IOL revealed that, ferritin and T2* were significantly different in the patients with IOL in cardiac tissue (p = 0.004 and p < 0.001), and, age, ferritin and R2 were significantly different in the patients with IOL in liver tissue (p = 0.036, p < 0.001 and p < 0.001). The MRI-based T2* and R2 values were moderately and inversely correlated with serum ferritin (r = −0.37; p < 0.001 and r = −0.46; p < 0.001). No correlations were found between the MRI-based T2*, R2 values and serum hepcidin. A moderate and positive correlation existed between serum ferritin and hepcidin (r = 0.45; p < 0.001). We considered that, enhanced intestinal iron absorption characterized by decreased serum hepcidin levels in the intervals between successive transfusions were resulted in iron accumulation in our patients.

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Authors and Affiliations

  1. Department of Hematology, Muğla Sıtkı Koçman University Training and Research Hospital, 48000, Muğla, Turkey

    Volkan Karakus

  2. Department of Biochemistry, Antalya Research and Training Hospital, 07000, Konyaaltı, Antalya, Turkey

    Ayşegül Kurtoğlu

  3. Department of Internal Medicine, Faculty of Medicine, Izmir University of Economics, 35360, Balçova, Izmir, Turkey

    Dilek Ersil Soysal

  4. Department of Pathology, Muğla Sıtkı Koçman University Faculty of Medicine, 48000, Muğla, Turkey

    Yelda Dere

  5. Department of Biostatistics and Medical Informatics, Akdeniz University Faculty of Medinice, 48000, Antalya, Turkey

    Selen Bozkurt

  6. Department of Hematology, Antalya Research and Training Hospital, 07000, Konyaaltı, Antalya, Turkey

    Volkan Karakus & Erdal Kurtoğlu

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  1. Volkan Karakus
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  2. Ayşegül Kurtoğlu
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  3. Dilek Ersil Soysal
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  4. Yelda Dere
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  6. Erdal Kurtoğlu
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Correspondence to Volkan Karakus.

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Informed consent was obtained from all the individual participitants included in this study.

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All procedures performed in studies involving human participants were inaccordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Karakus, V., Kurtoğlu, A., Soysal, D.E. et al. Evaluation of Iron Overload in the Heart and Liver Tissue by Magnetic Resonance Imaging and its Relation to Serum Ferritin and Hepcidin Concentrations in Patients with Thalassemia Syndromes. Indian J Hematol Blood Transfus 33, 389–395 (2017). https://doi.org/10.1007/s12288-016-0735-2

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