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Glycosylated ferritin as an improved marker for post-transfusion iron overload

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Abstract

Red blood cell (RBC) transfusion is an effective therapy for anemia, but repeated transfusions may cause iron overload-related damage to various organs. Iron chelation therapy, now widely available for patients who have received transfusions, is expected to reduce organ damage even in patients who received many transfusions. Therefore, determining when to start iron chelation therapy is important. In guidelines for iron chelation therapy, the serum ferritin level has been widely accepted as a practical marker for estimating iron overload. However, guidelines recommend multiple measurements of serum ferritin, because levels often fluctuate. Here, we investigated the usefulness of glycosylated ferritin as a marker of iron overload using a cohort consisted of 103 patients who had a total ferritin value over 1000 ng/mL. We found that the volume of RBCs transfused was clearly associated with the glycosylated ferritin level. We also found that acute inflammation, as represented by C-reactive protein values, was associated with increased non-glycosylated ferritin and that patients with hematopoietic diseases had higher glycosylated ferritin levels, possibly because of repeated RBC transfusions. We thus conclude that glycosylated ferritin may be an improved marker for predicting iron overload status.

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Authors and Affiliations

  1. Department of Clinical Laboratory Medicine, Kumamoto University Hospital, Kumamoto University, Kumamoto, Japan

    Ayako Ishihara, Tsuyuko Yamauchi, Yoko Fukuyoshi, Toshiro Yokoyama & Hirotaka Matsui

  2. Department of Medical Technology, Kumamoto Health Science University, Kumamoto, Japan

    Katsuyoshi Ikeda

  3. Department of Transfusion Medicine and Cell Therapy, Kumamoto University Hospital, Kumamoto University, Kumamoto, Japan

    Yuji Yonemura & Mitsuhiro Uchiba

  4. Department of Hematology, Rheumatology and Infectious Disease, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan

    Yuji Yonemura & Mitsuhiro Uchiba

  5. Department of Molecular Laboratory Medicine, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Hirotaka Matsui

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  1. Ayako Ishihara
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  2. Tsuyuko Yamauchi
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Ishihara, A., Yamauchi, T., Ikeda, K. et al. Glycosylated ferritin as an improved marker for post-transfusion iron overload. Int J Hematol 113, 537–546 (2021). https://doi.org/10.1007/s12185-020-03056-9

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  • DOI: https://doi.org/10.1007/s12185-020-03056-9

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