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Baskin-Miller J, Carson S, Jaffray J, Fletcher C, Singer J, Freyer DR, Wood J, Coates TD, Denton CC. Transfusional hemosiderosis in childhood cancer patients and survivors. Pediatr Blood Cancer 2024; 71:e31220. [PMID: 39096194 DOI: 10.1002/pbc.31220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/21/2024] [Accepted: 07/10/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Children treated for cancer are at risk for adverse effects of iron due to transfusions administered during prolonged marrow suppression, which may increase exposure to toxic forms of iron, extrahepatic iron accumulation, and long-term organ damage. OBJECTIVE This study aimed to characterize the severity and organ distribution of clinically significant, multisystem iron overload (IO) in an at-risk cohort of pediatric cancer patients. METHODS This was a retrospective, cross-sectional study of childhood cancer patients who underwent a magnetic resonance imaging (MRI) due to clinical concern for IO. Data regarding cancer type and treatment, transfusion history, MRI and laboratory results, and treatment for IO were collected. Severity of IO was analyzed by non-parametric tests with respect to clinical characteristics. RESULTS Of the 103 patients, 98% of whom had a Cancer Intensity Treatment Rating (ITR-3) of 3 or higher, 53% (54/102) had moderate or greater hepatic siderosis, 80% (77/96) had pancreatic siderosis, 4% (3/80) had cardiac siderosis, and 45% (13/29) had pituitary siderosis and/or volume loss. Pancreatic iron was associated with both cardiac (p = .0043) and pituitary iron (p = .0101). In the 73 off-therapy patients, ferritin levels were lower (p = .0008) with higher correlation with liver iron concentration (LIC) (p = .0016) than on-therapy patients. Fifty-eight subjects were treated for IO. CONCLUSION In this heavily treated cohort of pediatric cancer patients, more than 80% had extrahepatic iron loading, which occurs with significant exposure to toxic forms of iron related to decreased marrow activity in setting of transfusions. Further studies should examine the effects of exposure to reactive iron on long-term outcomes and potential strategies for management.
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Affiliation(s)
- Jacquelyn Baskin-Miller
- Division of Pediatric Hematology Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Susan Carson
- Children's Center for Cancer, Blood Diseases and Bone Marrow Transplantation, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Julie Jaffray
- Division of Pediatric Hematology Oncology, Rady Children's Hospital, San Diego, California, USA
| | - Craig Fletcher
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Jessie Singer
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - David R Freyer
- Children's Center for Cancer, Blood Diseases and Bone Marrow Transplantation, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - John Wood
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Thomas D Coates
- Children's Center for Cancer, Blood Diseases and Bone Marrow Transplantation, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Christopher C Denton
- Children's Center for Cancer, Blood Diseases and Bone Marrow Transplantation, Children's Hospital of Los Angeles, Los Angeles, California, USA
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2
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van Ooij P. Editorial for "Quantification of Cardiac Iron Overload at 3 T MRI in a Rabbit Model Utilizing ME-GRE T2* Sequence". J Magn Reson Imaging 2024. [PMID: 39172053 DOI: 10.1002/jmri.29540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 07/03/2024] [Indexed: 08/23/2024] Open
Affiliation(s)
- Pim van Ooij
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, The Netherlands
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3
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van Beers EJ, Al-Samkari H, Grace RF, Barcellini W, Glenthøj A, DiBacco M, Wind-Rotolo M, Xu R, Beynon V, Patel P, Porter JB, Kuo KHM. Mitapivat improves ineffective erythropoiesis and iron overload in adult patients with pyruvate kinase deficiency. Blood Adv 2024; 8:2433-2441. [PMID: 38330179 PMCID: PMC11112604 DOI: 10.1182/bloodadvances.2023011743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/20/2023] [Accepted: 01/06/2024] [Indexed: 02/10/2024] Open
Abstract
ABSTRACT Pyruvate kinase (PK) deficiency is a rare, hereditary disease characterized by chronic hemolytic anemia. Iron overload is a common complication regardless of age, genotype, or transfusion history. Mitapivat, an oral, allosteric PK activator, improves anemia and hemolysis in adult patients with PK deficiency. Mitapivat's impact on iron overload and ineffective erythropoiesis was evaluated in adults with PK deficiency who were not regularly transfused in the phase 3 ACTIVATE trial and long-term extension (LTE) (#NCT03548220/#NCT03853798). Patients in the LTE received mitapivat throughout ACTIVATE/LTE (baseline to week 96; mitapivat-to-mitapivat [M/M] arm) or switched from placebo (baseline to week 24) to mitapivat (week 24 to week 96; placebo-to-mitapivat [P/M] arm). Changes from baseline in markers of iron overload and erythropoiesis were assessed to week 96. Improvements in hepcidin (mean, 4770.0 ng/L; 95% confidence interval [CI], -1532.3 to 11 072.3), erythroferrone (mean, -9834.9 ng/L; 95% CI, -14 328.4 to -5341.3), soluble transferrin receptor (mean, -56.0 nmol/L; 95% CI, -84.8 to -27.2), and erythropoietin (mean, -32.85 IU/L; 95% CI, -54.65 to -11.06) were observed in the M/M arm (n = 40) from baseline to week 24, sustained to week 96. No improvements were observed in the P/M arm (n = 40) to week 24; however, upon transitioning to mitapivat, improvements similar to those observed in the M/M arm were seen. Mean changes from baseline in liver iron concentration by magnetic resonance imaging at week 96 in the M/M arm and the P/M arm were -2.0 mg Fe/g dry weight (dw; 95% CI, -4.8 to -0.8) and -1.8 mg Fe/g dw (95% CI, -4.4 to 0.80), respectively. Mitapivat is the first disease-modifying pharmacotherapy shown to have beneficial effects on iron overload and ineffective erythropoiesis in patients with PK deficiency. This trial was registered at www.ClinicalTrials.gov as #NCT03548220 (ACTIVATE) and #NCT03853798 (LTE).
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Affiliation(s)
- Eduard J. van Beers
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hanny Al-Samkari
- Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Rachael F. Grace
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | - Wilma Barcellini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andreas Glenthøj
- Danish Red Blood Cell Center, Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Rengyi Xu
- Agios Pharmaceuticals, Inc, Cambridge, MA
| | | | | | - John B. Porter
- Haematology Department, University College London Hospitals, London, United Kingdom
| | - Kevin H. M. Kuo
- Division of Hematology, University of Toronto, Toronto, ON, Canada
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4
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Sam AE, Weber Z, Peña A, Henderson C, King JM, Carr NR. A pilot study to evaluate clinical factors associated with iron and ferritin elevations during pediatric extracorporeal membrane oxygenation. Perfusion 2024; 39:585-592. [PMID: 36725017 DOI: 10.1177/02676591231154750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction: Elevations in serum ferritin and serum iron occur during pediatric extracorporeal membrane oxygenation (ECMO). Previous reports attribute the elevation to frequent red blood cell transfusions and/or hemolysis. Chronic transfusion can cause iron deposition in tissues leading to multisystem organ dysfunction. This study aims identify clinical factors associated with elevated ferritin and iron in pediatric ECMO patients, along with post-decannulation magnetic resonance imaging (MRI) assessment of iron deposition in liver and brain.Methods: Prospective, pilot study, using descriptive statistics to investigate potential associations between patient characteristics, serum ferritin and iron levels, and post-decannulation hepatic and basal ganglia iron deposition.Results: In this study, nine patients (100%) had elevated serum ferritin levels during ECMO. High ferritin levels were more common with veno-arterial than with veno-venous cannulation (p = 0.026) and were also associated with high plasma free hemoglobin levels (p < 0.001). Five patients presented with elevated serum iron levels. High serum iron levels were associated with higher daily (p = 0.016) and cumulative transfusion volumes (p = 0.013) as well ECMO duration beyond 7 days. MRI scans were performed on three patients with no evidence of abnormal iron deposition detected in the liver or brain.Conclusions: This pilot study shows that during pediatric ECMO, elevations in serum ferritin and serum iron occur and those elevations may be related to the cannulation modality, ECMO duration, amount of hemolysis, and volume of red blood cell transfusions. Further investigation is warranted to fully understand the implications of elevated serum iron and ferritin in pediatric ECMO.
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Affiliation(s)
- Ashley E Sam
- Brooke Army Medical Center, Fort Sam Houston, Texas, USA
- Department of Anesthesia, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Zachary Weber
- Brooke Army Medical Center, Fort Sam Houston, Texas, USA
- National Capital Consortium, Bethesda, MD, USA
| | - Alejandra Peña
- University Medical Center, Lubbock, TX, USA
- University of Texas Health Science Center San Antonio Joe and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Cody Henderson
- Children's Hospital of San Antonio, San Antonio, TX, USA
| | | | - Nicholas R Carr
- Brooke Army Medical Center, Fort Sam Houston, Texas, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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5
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Zekavat OR, Fallah Tafti F, Bordbar M, Parand S, Haghpanah S. Iron Overload in Children With Leukemia; Identification of a Cutoff Value for Serum Ferritin Level. J Pediatr Hematol Oncol 2024; 46:e137-e142. [PMID: 38132565 DOI: 10.1097/mph.0000000000002808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To determine the prevalence of iron overload in children with acute lymphoblastic leukemia (ALL) after treatment cessation and establish a cutoff value for serum ferritin level as an indicator of iron overload. BACKGROUND Early detection and monitoring of iron overload in patients with leukemia is crucial. METHODS In this prospective cohort study, 66 pediatric patients with ALL who were treated at a tertiary referral center affiliated with Shiraz University of Medical Sciences in Shiraz, Southern Iran, were investigated from July 2020 to December 2022. Serum ferritin levels were measured 6 months after treatment completion. T2* magnetic resonance imaging of the liver and heart was done for all patients. The receiver operating characteristic curve was used to illustrate the area under the receiver operating characteristic curve to assess the diagnostic value of serum ferritin level and total transfusion volume. RESULTS A total of 24 patients (36.4%) had iron overload in the heart or liver based on T2 magnetic resonance imaging findings. Serum ferritin level was a highly accurate diagnostic marker for iron overload in pediatric patients with ALL, with a sensitivity of 95.8%, and specificity of 85.7% for a cutoff value of 238.5 ng/mL. Also, blood transfusion was a good predictor of iron overload a sensitivity of 75% and specificity of 81% for a cutoff value of 28.3 mL/kg. CONCLUSION We identified specific cutoff values for serum ferritin and blood transfusion volume to predict iron overload with high sensitivity and specificity. These markers offer a cost-effective and accessible approach for periodic screening of iron deposition, particularly in resource-constrained settings.
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Affiliation(s)
- Omid Reza Zekavat
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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6
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Zhang J, Su T, Fan Y, Cheng C, Xu L, LiTian. Spotlight on iron overload and ferroptosis: Research progress in female infertility. Life Sci 2024; 340:122370. [PMID: 38141854 DOI: 10.1016/j.lfs.2023.122370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Abstract
Iron is an essential trace element for organisms. However, iron overload, which is common in haematological disorders (e.g. haemochromatosis, myelodysplastic syndromes, aplastic anaemia, and thalassaemia, blood transfusion-dependent or not), can promote reactive oxygen species generation and induce ferroptosis, a novel form of programmed cell death characterised by excess iron and lipid peroxidation, thus causing cell and tissue damage. Infertility is a global health concern. Recent evidence has indicated the emerging role of iron overload and ferroptosis in female infertility by inducing hypogonadism, causing ovary dysfunction, impairing preimplantation embryos, attenuating endometrial receptivity, and crosstalk between subfertility-related disorders, such as polycystic ovary syndrome and endometriosis. In addition, gut microbiota and their metabolites are involved in iron metabolism, ferroptosis, and female infertility. In this review, we systematically elaborate on the current research progress in female infertility with a novel focus on iron overload and ferroptosis and summarise promising therapies targeting iron overload and ferroptosis to recover fertility in women. In summary, our study provides new insights into female infertility and offers literature references for the clinical management of female infertility associated with iron overload and ferroptosis, which may be beneficial for females with haematopoietic disorders suffering from both iron overload and infertility.
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Affiliation(s)
- Jinghua Zhang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China; Reproductive Medical Center, Peking University People's Hospital, Beijing 100044, China
| | - Tiantian Su
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China; Reproductive Medical Center, Peking University People's Hospital, Beijing 100044, China
| | - Yuan Fan
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China; Reproductive Medical Center, Peking University People's Hospital, Beijing 100044, China
| | - Cheng Cheng
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China; Reproductive Medical Center, Peking University People's Hospital, Beijing 100044, China
| | - Lanping Xu
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital & Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - LiTian
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China; Reproductive Medical Center, Peking University People's Hospital, Beijing 100044, China.
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7
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Yu JY, Kim TH, Kim YJ, Kang HM, Yoo IH, Rhim JW, Lee SY, Jeong DC. Macrophage activation syndrome in neonatal lupus presenting with fever and rash. JOURNAL OF RHEUMATIC DISEASES 2024; 31:49-53. [PMID: 38130956 PMCID: PMC10730804 DOI: 10.4078/jrd.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 01/01/2020] [Accepted: 01/01/2020] [Indexed: 12/23/2023]
Abstract
Neonatal lupus can occur in infants born to mother with autoimmune disorders through transplacental auto-antibodies. Clinical manifestations in neonatal lupus include cutaneous lesions and hematologic or hepatobiliary findings resembling those seen in systemic lupus erythematosus. In autoimmune state, macrophage activation syndrome (MAS) represent a critical and potentially fatal complication that can result in mortality if not immediately identified and managed with the appropriate care. Here we present a 33-day-old girl diagnosed with neonatal lupus and serious MAS. She was delivered by a primipara mother who did not exhibit any autoimmune symptoms. The patient visited the hospital due to fever and pancytopenia. Laboratory data were compatible with MAS, including pancytopenia, high level of ferritin, soluble interleukin-2, and decreased natural killer cell activity. In addition, autoimmune study showed positive results for anti-nuclear antibody (ANA), anti-Sjogren syndrome antigen A (SSA), and SSB, The autoimmune study for mother also showed positive results for ANA, anti-SSA, and SSB. The patient recovered after she received high dose steroid and supportive care. Our case indicates that neonatal lupus should be taken into consideration when fever, erythematous skin rash, and pancytopenia are observed in infants, even if their mothers have no prior history of autoimmune conditions.
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Affiliation(s)
- Ji Yoon Yu
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae Hwan Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ye Ji Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Mi Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Hyuk Yoo
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Woo Rhim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Young Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dae Chul Jeong
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Brendel JM, Kratzenstein A, Berger J, Hagen F, Nikolaou K, Gawaz M, Greulich S, Krumm P. T2* map at cardiac MRI reveals incidental hepatic and cardiac iron overload. Diagn Interv Imaging 2023; 104:552-559. [PMID: 37550171 DOI: 10.1016/j.diii.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE The purpose of this study was to assess the diagnostic capabilities of cardiac magnetic resonance (CMR) T2* mapping in detecting incidental hepatic and cardiac iron overload. MATERIALS AND METHODS Patients with various clinical indications for CMR examination were consecutively included at a single center from January 2019 to April 2023. All patients underwent T2* mapping at 1.5 T in a single mid-ventricular short-axis as part of a comprehensive routine CMR protocol. T2* measurements were performed of the heart (using a region-of-interest in the interventricular septum) and the liver, categorized according to the severity of iron overload. The degree of cardiac iron overload was categorized as mild (15 ms < T2* < 20 ms), moderate (10 ms < T2* < 15 ms) and severe (T2* < 10 ms). The degree of hepatic iron overload was categorized as mild (4 ms < T2* < 8 ms), moderate (2 ms < T2* < 4 ms), severe (T2* < 2 ms). Image quality and inter-reader agreement were assessed using intraclass correlation coefficient (ICC). RESULTS CMR examinations from 614 patients (374 men, 240 women) with a mean age of 50 ± 18 (standard deviation) years were fully evaluable. A total of 24/614 patients (3.9%) demonstrated incidental hepatic iron overload; of these, 22/614 patients (3.6%) had mild hepatic iron overload, and 2/614 patients (0.3%) had moderate hepatic iron overload. Seven out of 614 patients (1.1%) had incidental cardiac iron overload; of these, 5/614 patients (0.8%) had mild iron overload, 1/614 patients (0.2%) had moderate iron overload, and 1/614 patients (0.2%) had severe iron overload. Good to excellent inter-reader agreement was observed for the assessment of T2* values (ICC, 0.90 for heart [95% confidence interval: 0.88-0.91]; ICC, 0.91 for liver [95% confidence interval: 0.89-0.92]). CONCLUSION Analysis of standard CMR T2* maps detects incidental cardiac and hepatic iron overload in 1.1% and 3.9% of patients, respectively, which may have implications for further patient management. Therefore, despite an overall low number of incidental abnormal findings, T2* imaging may be included in a standardized comprehensive CMR protocol.
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Affiliation(s)
- Jan M Brendel
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany
| | - Alina Kratzenstein
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany
| | - Josephine Berger
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany
| | - Florian Hagen
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany
| | - Meinrad Gawaz
- Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen, 72076 Germany
| | - Simon Greulich
- Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen, 72076 Germany.
| | - Patrick Krumm
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany
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Tsujita Y, Sofue K, Ueshima E, Ueno Y, Hori M, Murakami T. Clinical Application of Quantitative MR Imaging in Nonalcoholic Fatty Liver Disease. Magn Reson Med Sci 2023; 22:435-445. [PMID: 35584952 PMCID: PMC10552668 DOI: 10.2463/mrms.rev.2021-0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/23/2022] [Indexed: 11/09/2022] Open
Abstract
Viral hepatitis was previously the most common cause of chronic liver disease. However, in recent years, nonalcoholic fatty liver disease (NAFLD) cases have been increasing, especially in developed countries. NAFLD is histologically characterized by fat, fibrosis, and inflammation in the liver, eventually leading to cirrhosis and hepatocellular carcinoma. Although biopsy is the gold standard for the assessment of the liver parenchyma, quantitative evaluation methods, such as ultrasound, CT, and MRI, have been reported to have good diagnostic performances. The quantification of liver fat, fibrosis, and inflammation is expected to be clinically useful in terms of the prognosis, early intervention, and treatment response for the management of NAFLD. The aim of this review was to discuss the basics and prospects of MRI-based tissue quantifications of the liver, mainly focusing on proton density fat fraction for the quantification of fat deposition, MR elastography for the quantification of fibrosis, and multifrequency MR elastography for the evaluation of inflammation.
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Affiliation(s)
- Yushi Tsujita
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Eisuke Ueshima
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yoshiko Ueno
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Masatoshi Hori
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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van Hattem J, Maes P, Esterhuizen TM, Devos A, Ruppert M, van Heerden J. Erythrocytapheresis in Children and Young Adults with Hemoglobinopathies and Iron Overload in Need of Iron Chelation Therapy. J Clin Med 2023; 12:6287. [PMID: 37834930 PMCID: PMC10573872 DOI: 10.3390/jcm12196287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Limited data regarding erythrocytapheresis in children, adolescents, and young adults have been published. The aim of this study was to evaluate erythrocytapheresis, either as a standalone therapy or in combination with iron chelation therapy, in children and young adults with hemoglobinopathies in whom current iron chelation therapy is not sufficient in decreasing the iron overload during management. We retrospectively analysed erythrocytapheresis in 19 patients with hemoglobinopathies in need of iron chelation therapy diagnosed with sickle cell disease (SCD) or β-thalassemia major. Patients were divided into (1) a case cohort who received erythrocytapheresis alone or in combination with iron chelation therapy and (2) a control cohort who received oral iron chelation therapy alone. Serum ferritin and haemoglobin levels were compared at five different time points over a one-year period. In the erythrocytapheresis cohort, there was a significant decrease in serum ferritin (p < 0.001). In the iron chelation therapy alone cohort, there was no significant decrease in serum ferritin over time (p = 0.156). Comparing the evolution of median serum ferritin between therapy with erythrocytapheresis and iron chelation therapy showed a statistically significant difference (p = 0.008). Patients with β-thalassemia major receiving erythrocytapheresis showed a greater reduction in serum ferritin compared to patients without (p = 0.036). A difference could not be shown between the erythrocytapheresis and iron chelation single therapies (p = 0.100). This study showed an overall significant reduction in serum ferritin in patients with hemoglobinopathies treated with erythrocytapheresis in addition to iron chelation. A clinical, although not statistical, trend of higher haemoglobin levels was maintained. Erythrocytapheresis in paediatric patients with β-thalassemia major was as effective in decreasing ferritin levels as in previously reported studies with SCD. Erythrocytapheresis is a promising therapy for treating and preventing transfusion-related iron overload.
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Affiliation(s)
- Jessica van Hattem
- Department of Paediatrics and Child Health, Antwerp University Hospital, 2650 Antwerp, Belgium
| | - Philip Maes
- Department of Paediatric Haematology and Oncology, Antwerp University Hospital, 2650 Antwerp, Belgium; (P.M.); (A.D.); (J.v.H.)
| | - Tonya Marianne Esterhuizen
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa;
| | - Ann Devos
- Department of Paediatric Haematology and Oncology, Antwerp University Hospital, 2650 Antwerp, Belgium; (P.M.); (A.D.); (J.v.H.)
| | - Martin Ruppert
- Department of Abdominal, Paediatric and Reconstructive Surgery, Antwerp University Hospital, 2650 Antwerp, Belgium;
| | - Jaques van Heerden
- Department of Paediatric Haematology and Oncology, Antwerp University Hospital, 2650 Antwerp, Belgium; (P.M.); (A.D.); (J.v.H.)
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11
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Phansalkar R, Kambham N, Charu V. Liver Pathology After Hematopoietic Stem Cell Transplantation. Surg Pathol Clin 2023; 16:519-532. [PMID: 37536886 DOI: 10.1016/j.path.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Hematopoietic stem cell transplantation is used to treat a variety of hematologic malignancies and autoimmune conditions. The immunosuppressive medications as well as other therapies used both before and after transplantation leave patients susceptible to a wide spectrum of complications, including liver injury. Causes for liver damage associated with stem cell transplantation include sinusoidal obstruction syndrome, graft-versus-host disease, iron overload, and opportunistic infection. Here, the authors review the clinical and pathological findings of these etiologies of liver injury and provide a framework for diagnosis.
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Affiliation(s)
- Ragini Phansalkar
- Department of Pathology, Lane Building, L235, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Neeraja Kambham
- Department of Pathology, Lane Building, L235, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Vivek Charu
- Department of Pathology, Lane Building, L235, 300 Pasteur Drive, Stanford, CA 94305, USA; Department of Medicine, Quantitative Sciences Unit, Stanford, CA, USA.
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Chapchap EC, Silva MMA, Baroni RH, Araujo ADS, de Assis RA, Loggetto SR, Junior AF, Verissimo MPDA, Baldanzi GR, Fertrin KY, Tricta F, Piga AG, Hamerschlak N. Extramedullary haematopoiesis in patients with thalassemia: a cross-sectional description of its prevalence, clinical features and survival. Hematol Transfus Cell Ther 2023:S2531-1379(23)00158-X. [PMID: 37690980 DOI: 10.1016/j.htct.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/06/2023] [Accepted: 07/07/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION Despite knowledge advances on extramedullary haematopoiesis (EMH) in thalassemic patients, the real picture remains an open issue. OBJECTIVES To assess EMH prevalence in patients with thalassemia major (TM) and intermedia (TI), to describe magnetic resonance imaging (MRI) findings and to explore clinical risk factors. METHODS In this cross-sectional study, images and clinical records of 184 consecutive patients with thalassemia who underwent T2* MRI between 2004 and 2011 were reviewed. Association of EMH with survival was investigated for patients with available follow-up charts. RESULTS EMH was detected in 16/168 (9.5%) patients with TM (aged 19-49 years) and in 3/16 (18.8%) with TI (aged 36-41 years). Most (88%) had paravertebral thoracic and/or abdominal masses. Age was significantly associated with EMH risk (hazard ratio, [HR] 1.10/year; confidence interval [CI]: 1.03-1.18; p-value < 0.001), while lower pancreatic iron content by T2*MRI (HR: 0.94/ms; CI: 0.89-0.99; p-value = 0.049) was a protective factor. Estimated survival rate was superior for EMH-positive (n = 19) when compared to EMH-negative patients (n = 75) (p-value = 0.013). CONCLUSIONS The prevalence of EMH was 10.3% (19/184), presented mainly as tumoral masses of 3 to 10 cm. Age was a risk factor for EMH development, while lower pancreatic iron might be a protective factor in this cohort.
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Guglielmo FF, Barr RG, Yokoo T, Ferraioli G, Lee JT, Dillman JR, Horowitz JM, Jhaveri KS, Miller FH, Modi RY, Mojtahed A, Ohliger MA, Pirasteh A, Reeder SB, Shanbhogue K, Silva AC, Smith EN, Surabhi VR, Taouli B, Welle CL, Yeh BM, Venkatesh SK. Liver Fibrosis, Fat, and Iron Evaluation with MRI and Fibrosis and Fat Evaluation with US: A Practical Guide for Radiologists. Radiographics 2023; 43:e220181. [PMID: 37227944 DOI: 10.1148/rg.220181] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Quantitative imaging biomarkers of liver disease measured by using MRI and US are emerging as important clinical tools in the management of patients with chronic liver disease (CLD). Because of their high accuracy and noninvasive nature, in many cases, these techniques have replaced liver biopsy for the diagnosis, quantitative staging, and treatment monitoring of patients with CLD. The most commonly evaluated imaging biomarkers are surrogates for liver fibrosis, fat, and iron. MR elastography is now routinely performed to evaluate for liver fibrosis and typically combined with MRI-based liver fat and iron quantification to exclude or grade hepatic steatosis and iron overload, respectively. US elastography is also widely performed to evaluate for liver fibrosis and has the advantage of lower equipment cost and greater availability compared with those of MRI. Emerging US fat quantification methods can be performed along with US elastography. The author group, consisting of members of the Society of Abdominal Radiology (SAR) Liver Fibrosis Disease-Focused Panel (DFP), the SAR Hepatic Iron Overload DFP, and the European Society of Radiology, review the basics of liver fibrosis, fat, and iron quantification with MRI and liver fibrosis and fat quantification with US. The authors cover technical requirements, typical case display, quality control and proper measurement technique and case interpretation guidelines, pitfalls, and confounding factors. The authors aim to provide a practical guide for radiologists interpreting these examinations. © RSNA, 2023 See the invited commentary by Ronot in this issue. Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Flavius F Guglielmo
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Richard G Barr
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Takeshi Yokoo
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Giovanna Ferraioli
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - James T Lee
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Jonathan R Dillman
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Jeanne M Horowitz
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Kartik S Jhaveri
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Frank H Miller
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Roshan Y Modi
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Amirkasra Mojtahed
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Michael A Ohliger
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Ali Pirasteh
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Scott B Reeder
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Krishna Shanbhogue
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Alvin C Silva
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Elainea N Smith
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Venkateswar R Surabhi
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Bachir Taouli
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Christopher L Welle
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Benjamin M Yeh
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
| | - Sudhakar K Venkatesh
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, PA 19107 (F.F.G.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (T.Y.); Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy (G.F.); Department of Radiology, University of Kentucky, Lexington, Ky (J.T.L.); Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (J.M.H., F.H.M.); Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada (K.S.J.); Department of Radiology, ChristianaCare, Newark, Del (R.Y.M.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.M.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (M.A.O., B.M.Y.); Departments of Radiology and Medical Physics (A.P.) and Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, NYU Langone Health, New York, NY (K.S.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.C.S.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (E.N.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S.); Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (B.T.); and Department of Radiology, Mayo Clinic, Rochester, Minn (C.L.W., S.K.V.)
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14
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Schiano E, Cappello E, Cecere D, Pompeo F, Novellino E, Stornaiuolo M, Izzo M. Increased Levels of Circulating Iron-Albumin Complexes in Peripheral Arterial Disease Patients. Antioxidants (Basel) 2023; 12:antiox12020503. [PMID: 36830061 PMCID: PMC9952351 DOI: 10.3390/antiox12020503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
Under physiological conditions, extracellular iron circulates in the blood bound to transferrin. As a consequence of several pathologies, the circulating level of a Non-Transferrin Bound pool of Iron (NTBI) increases. The NTBI pool is biologically heterogeneous and represented by iron chelated either by small metabolites (citrate, amino acids, or cofactors) or by serum proteins. By promoting reactive oxygen species (ROS) and reactive nitrogen species (RNS) formation, NTBI causes oxidative stress and alteration of membrane lipids, seriously compromising the healthy state of organs and tissues. While NTBI involvement in several pathologies has been clarified, its contribution to vascular diseases remains to be investigated. Here we measure and analyze the pool of NTBI in the serum of a small group of peripheral arterial disease (PAD) patients. We show that: (i) the NTBI pool shifts from low molecular complexes to high-molecular ones in PAD patients compared to healthy controls; (ii) most of this NTBI is bound to the serum protein Albumin; (iii) this NTBI-Albumin complex can be isolated and quantitated following a simple immunoisolation procedure amenable to automation and suitable for clinical screening purposes.
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Affiliation(s)
- Elisabetta Schiano
- Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy
| | | | | | | | - Ettore Novellino
- Department of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Mariano Stornaiuolo
- Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy
- Correspondence: (M.S.); (M.I.)
| | - Marcello Izzo
- MathTechMed-Department of Mathematics for Technology, Medicine and Biosciences Research Center, University of Ferrara, 44121 Ferrara, Italy
- Correspondence: (M.S.); (M.I.)
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15
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Chapchap EC, Silva MMA, de Assis RA, Kerbauy LN, Diniz MDS, Rosemberg LA, Loggetto SR, Araujo ADS, Fabron Junior A, Verissimo MPDA, Baldanzi GR, Esposito BP, Tricta F, Steagall MEA, Vellozo CÂGDS, Fertrin KY, Baroni RH, Hamerschlak N. Cardiac iron overload evaluation in thalassaemic patients using T2* magnetic resonance imaging following chelation therapy: a multicentre cross-sectional study. Hematol Transfus Cell Ther 2023; 45:7-15. [PMID: 34090847 PMCID: PMC9938451 DOI: 10.1016/j.htct.2021.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/28/2020] [Accepted: 01/27/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) T2* technique is used to assess iron overload in the heart, liver and pancreas of thalassaemic patients. Optimal iron chelation and expected tissue iron response rates remain under investigation. The objective of this study was to analyse serum ferritin and the iron concentration in the heart, liver and pancreas measured by MRI T2*/R2* during regular chelation therapy in a real-world cohort of patients with thalassemia. METHODS We evaluated thalassaemic patients ≥ 7 years old undergoing chelation/transfusion therapy by MRI and assessed serum ferritin at baseline and follow-up from 2004-2011. RESULTS We evaluated 136 patients, 92% major thalassaemic, with a median age of 18 years, and median baseline ferritin 2.033ng/ml (range: 59-14,123). Iron overload distribution was: liver (99%), pancreas (74%) and heart (36%). After a median of 1.2 years of follow-up, the iron overload in the myocardium reduced from 2,63 Fe mg/g to 2,05 (p 0.003). The optimal R2* pancreas cut-off was 148 Hertz, achieving 78% sensitivity and 73% specificity. However, when combining the R2* pancreas cut off ≤ 50 Hertz and a ferritin ≤ 1222 ng/ml, we could reach a negative predictive value (NPV) of 98% for cardiac siderosis. Only 28% were undergoing combined chelation at baseline assessment, which increased up to 50% on follow up evaluation. CONCLUSIONS Chelation therapy significantly reduced cardiac siderosis in thalassaemic patients. In patients with moderate/severe liver iron concentration undergoing chelation therapy, ferritin levels and myocardium iron improved earlier than the liver siderosis.
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16
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Duan G, Li J, Duan Y, Zheng C, Guo Q, Li F, Zheng J, Yu J, Zhang P, Wan M, Long C. Mitochondrial Iron Metabolism: The Crucial Actors in Diseases. Molecules 2022; 28:29. [PMID: 36615225 PMCID: PMC9822237 DOI: 10.3390/molecules28010029] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Iron is a trace element necessary for cell growth, development, and cellular homeostasis, but insufficient or excessive level of iron is toxic. Intracellularly, sufficient amounts of iron are required for mitochondria (the center of iron utilization) to maintain their normal physiologic function. Iron deficiency impairs mitochondrial metabolism and respiratory activity, while mitochondrial iron overload promotes ROS production during mitochondrial electron transport, thus promoting potential disease development. This review provides an overview of iron homeostasis, mitochondrial iron metabolism, and how mitochondrial iron imbalances-induced mitochondrial dysfunction contribute to diseases.
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Affiliation(s)
- Geyan Duan
- CAS Key Laboratory of Agro-Ecological Processes in Subtropical Region, Hunan Provincial Key Laboratory of Animal Nutritional Physiology and Metabolic Process, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha 410125, China
- College of Advanced Agricultural Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jianjun Li
- CAS Key Laboratory of Agro-Ecological Processes in Subtropical Region, Hunan Provincial Key Laboratory of Animal Nutritional Physiology and Metabolic Process, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha 410125, China
- College of Advanced Agricultural Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yehui Duan
- CAS Key Laboratory of Agro-Ecological Processes in Subtropical Region, Hunan Provincial Key Laboratory of Animal Nutritional Physiology and Metabolic Process, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha 410125, China
- College of Advanced Agricultural Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Changbing Zheng
- College of Animal Science and Technology, Hunan Agricultural University, Changsha 410128, China
| | - Qiuping Guo
- CAS Key Laboratory of Agro-Ecological Processes in Subtropical Region, Hunan Provincial Key Laboratory of Animal Nutritional Physiology and Metabolic Process, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha 410125, China
- College of Advanced Agricultural Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Fengna Li
- CAS Key Laboratory of Agro-Ecological Processes in Subtropical Region, Hunan Provincial Key Laboratory of Animal Nutritional Physiology and Metabolic Process, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha 410125, China
- College of Advanced Agricultural Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jie Zheng
- CAS Key Laboratory of Agro-Ecological Processes in Subtropical Region, Hunan Provincial Key Laboratory of Animal Nutritional Physiology and Metabolic Process, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha 410125, China
- College of Advanced Agricultural Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jiayi Yu
- CAS Key Laboratory of Agro-Ecological Processes in Subtropical Region, Hunan Provincial Key Laboratory of Animal Nutritional Physiology and Metabolic Process, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha 410125, China
- College of Advanced Agricultural Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Peiwen Zhang
- College of Animal Science and Technology, Hunan Agricultural University, Changsha 410128, China
| | - Mengliao Wan
- College of Animal Science and Technology, Hunan Agricultural University, Changsha 410128, China
| | - Cimin Long
- CAS Key Laboratory of Agro-Ecological Processes in Subtropical Region, Hunan Provincial Key Laboratory of Animal Nutritional Physiology and Metabolic Process, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha 410125, China
- College of Advanced Agricultural Sciences, University of Chinese Academy of Sciences, Beijing 100049, China
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17
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de Wilde JRA, van Dooijeweert B, van Vuren AJ, Huisman EJ, Smiers FJ, van der Veer A, van Wijk R, van Solinge WW, Nieuwenhuis EES, van Beers EJ, Bartels M. Transfusion burden in early childhood plays an important role in iron overload in Diamond-Blackfan anaemia. EJHAEM 2022; 3:1300-1304. [PMID: 36467824 PMCID: PMC9713217 DOI: 10.1002/jha2.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 06/17/2023]
Abstract
In Diamond-Blackfan anaemia (DBA), iron overload (IO) is common in transfusion-dependent patients, yet has also been reported in non-transfusion-dependent patients. We explored the incidence of IO in transfusion-dependent and non-transfusion-dependent DBA patients. We observed hepatic IO in 65% of patients analysed with MRI, including three patients that were only treated with transfusions in the past. Whereas overall ferritin levels and liver iron content correlated, ferritin levels did not reflect total body iron adequately. Our data suggest that transfusion burden in the past plays an important role in IO in DBA, and should be taken into account during follow up.
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Affiliation(s)
- Jonathan R. A. de Wilde
- Central Diagnostic Laboratory‐ResearchUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Birgit van Dooijeweert
- Central Diagnostic Laboratory‐ResearchUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
- Department of Paediatric HaematologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Annelies J. van Vuren
- Centre for Benign HaematologyThrombosis and HaemostasisVan CreveldkliniekUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Elise J. Huisman
- Department of Paediatric HaematologyErasmus Medical CentreRotterdamThe Netherlands
| | - Frans J. Smiers
- Department of Paediatric HaematologyLeiden University Medical Centre LeidenLeidenThe Netherlands
| | - Arian van der Veer
- Department of Paediatric HaematologyMaastricht University Medical CentreMaastrichtThe Netherlands
- Department of Paediatric HaematologyAmalia Children's HospitalRadboudUMCNijmegenThe Netherlands
| | - Richard van Wijk
- Central Diagnostic Laboratory‐ResearchUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Wouter W. van Solinge
- Central Diagnostic Laboratory‐ResearchUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Edward E. S. Nieuwenhuis
- Department of Paediatric HaematologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Eduard J. van Beers
- Centre for Benign HaematologyThrombosis and HaemostasisVan CreveldkliniekUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Marije Bartels
- Department of Paediatric HaematologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
- Centre for Benign HaematologyThrombosis and HaemostasisVan CreveldkliniekUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
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18
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Kobalava ZD, Lapshin AA, Tolkacheva VV, Galochkin SA. Prevalence and clinical associations of iron deficiency in patients with decompensated heart failure, depending on the diagnostic criteria used for iron deficiency. TERAPEVT ARKH 2022; 94:844-849. [DOI: 10.26442/00403660.2022.07.201716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Indexed: 11/22/2022]
Abstract
Aim. To compare the frequency of iron deficiency (ID) in patients with decompensated heart failure (HF), defined by international guideline criterion ferritin 100 ng/ml or ferritin from 100 to 299 ng/ml with TSAT20% (criterion A) and by bone marrow biopsy criterion TSAT19.8% and serum iron 13 mol/l (criterion B); to evaluate the effect of ID, diagnosed on the basis of different ID criteria, on NT pro-BNP, sST2, CRP levels and New York Heart Association (NYHA) functional classes (FC) distribution between groups with ID and without ID.
Materials and methods. The study included 223 patients (median age 73 [65; 82] years, 58% males) who were hospitalized to V.V. Vinogradov Moscow City Clinical Hospital No. 64 with decompensated HF. All patients underwent a standard physiological examination, laboratory and instrumental studies, including determination of NT-proBNP, sST2, CRP, and ferrokinetic parameters (serum iron, transferrin, ferritin). TSAT was calculated as: serum iron / transferrin 3.98. NYHA FC was determined according to Heart Failure Severity Rating Scale score. All patients underwent echocardiography to assess the ejection fraction of the left ventricle.
Results. According to criterion A ID was detected in 89% (n=199) of patients. There were no significant differences between levels of CRP, NT-proBNP and sST2. According to criterion B ID was detected in 70% (n=156) of patients. In the ID group, higher levels of CRP (15.1 mg/l vs 6.2 mg/l, p0.001), NT-proBNP (5422 pg/ml vs 2380 pg/ml, p0.001) and sST2 (59.6 ng/ml vs 42 ng/ml, p=0.02) were detected. Intravenous FCM admission according to current international guidelines (diagnosis of ID according to criterion A) is recommended to 57% of patients included in this study. Both methods formed groups with ID, in which patients had higher NYHA FC compared to groups without ID. According to current clinical guidelines, iron deficiency should be assessed according to method 1. More than half of patients (57, n=127) have indications for intravenous FCM to reduce risk of HF hospitalizations.
Conclusion. The frequency of ID in patients with decompensated heart failure varies from 70 to 89% depending on the criterion used to diagnose ID, but in any case, remains high. Intravenous FCM should be prescribed in 57% (n=127) of patients. Criterion B, validated against the gold standard of diagnostics, unlike criterion A, makes it possible to form groups of patients with ID and without ID, significantly differing in CRP, NT-proBNP, and sST2 levels.
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Amin K, Mileto A, Kolokythas O. MRI for Liver Iron Quantification: Concepts and Current Methods. Semin Ultrasound CT MR 2022; 43:364-370. [PMID: 35738822 DOI: 10.1053/j.sult.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Liver Iron content is best correlated to total body iron stores and is thus the organ of choice for evaluation in iron overload diseases. Liver biopsy was the historic standard for iron evaluation, but the evaluation is localized, comes with increased risks due to its invasiveness, and is costly. MRI is now widely used for liver iron evaluation. The superparamagnetic properties of iron cause a disturbance in magnetic resonance imaging, which can be evaluated with various techniques. These include signal intensity ratio (SIR), T2 relaxometry, T2* relaxometry, and Dixon-based solutions. Each of the methods has its own advantages and disadvantages, and factors such as availability, ease of use, accuracy, reproducibility, and cost can all play a role in the ultimate technique used for liver iron quantification. Quantitative susceptibility mapping, and ultrashort TE sequences are promising supplemental methods, but are primarily used as research sequences. These may become more clinically accepted in the near future. Dual energy CT is also being explored as an alternative but is still in the nascent stages. Overall, accurate liver iron concentration is feasible with the current tools available at most MR imaging centers and is highly valuable for evaluation of iron overload diseases.
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Affiliation(s)
- Kathan Amin
- Department of Radiology, University of Washington, Seattle, WA.
| | - Achille Mileto
- Department of Radiology, University of Washington, Seattle, WA
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20
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Ryan E, Mulready K, Wiegerinck E, Russell J, Swinkels DW, Stewart S. NTBI levels in C282Y homozygotes after therapeutic phlebotomy. EJHAEM 2022; 3:644-652. [PMID: 36051052 PMCID: PMC9422009 DOI: 10.1002/jha2.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022]
Abstract
C282Y homozygotes exposed to sustained elevated transferrin saturation (TS) may develop worsening clinical symptoms. This might be related to the appearance of non-transferrin bound iron (NTBI) when TS≥50% and labile plasma iron (LPI) when TS levels reach 75-80%. In this study, NTBI levels were examined in 219 randomly selected untreated and treated C282Y homozygotes. Overall, 161 of 219 had TS ≥ 50%, 124 of whom had detectable NTBI (≥0.47 µM, 1.81 µM [0.92-2.46 µM]) with a median serum ferritin 320 µg/L (226-442 µg/L). Ninety of 219 homozygotes had TS ≥ 75%, and all had detectable NTBI (2.21 µM [1.53-2.59 µM] with a median ferritin 338 µg/L [230-447 µg/L]). Of 125 homozygotes who last had phlebotomy ≥12 months ago (42 months [25-74 months], 92 had TS levels ≥ 50%, and 70 of these had NTBI ≥ 0.47 µM (2.06 µM [1.23-2.61µM]). Twenty-six of these 70 had a normal ferritin. Fifty-five of 125 had TS ≥ 75%, and NTBI was detected in all of these (2.32 µM [1.57-2.77 µM]) with a median ferritin 344 µg/L (255-418 µg/L). Eighteen of these 55 had a normal ferritin. In summary, NTBI is frequently found in C282Y homozygotes with TS ≥ 50%. Furthermore, C282Y homozygotes in the maintenance phase often have TS ≥ 50% together with a normal ferritin. Therefore, monitoring the TS level during the maintenance phase is recommended as an accessible clinical marker of the presence of NTBI.
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Affiliation(s)
- Eleanor Ryan
- Liver CentreMater Misericordiae University HospitalDublinIreland
| | - Keith Mulready
- Department of Biochemistry and Diagnostic EndocrinologyMater Misericordiae University HospitalDublinIreland
| | - Erwin Wiegerinck
- Laboratory of Genetic, Endocrine and Metabolic Diseases, Department of Laboratory MedicineRadboud University Medical CentreNijmegenThe Netherlands
| | - Jennifer Russell
- Liver CentreMater Misericordiae University HospitalDublinIreland
| | - Dorine W. Swinkels
- Laboratory of Genetic, Endocrine and Metabolic Diseases, Department of Laboratory MedicineRadboud University Medical CentreNijmegenThe Netherlands
| | - Stephen Stewart
- Liver CentreMater Misericordiae University HospitalDublinIreland
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21
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Roth TL, Philpott M, Wojtusik J. Rhinoceros serum labile plasma iron and associated redox potential: interspecific variation, sex bias and iron overload disorder disconnect. CONSERVATION PHYSIOLOGY 2022; 10:coac025. [PMID: 37155459 PMCID: PMC9040876 DOI: 10.1093/conphys/coac025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/13/2021] [Accepted: 03/28/2022] [Indexed: 05/10/2023]
Abstract
A consequence of the poaching crisis is that managed rhinoceros populations are increasingly important for species conservation. However, black rhinoceroses (BR; Diceros bicornis) and Sumatran rhinoceroses (SR; Dicerorhinus Sumatrensis) in human care often store excessive iron in organ tissues, a condition termed iron overload disorder (IOD). IOD research is impeded by the challenge of accurately monitoring body iron load in living rhinoceroses. The goals of this study were to (i) determine if labile plasma iron (LPI) is an accurate IOD biomarker and (ii) identify factors associated with iron-independent serum oxidative reduction potential (ORP). Serum (106 samples) from SRs (n = 8), BRs (n = 28), white rhinoceros (n = 24) and greater one-horned rhinoceros (GOH; n = 16) was analysed for LPI. Samples from all four species tested positive for LPI, and a higher proportion of GOH rhinoceros samples were LPI positive compared with those of the other three species (P < 0.05). In SRs, the only LPI-positive samples were those from individuals clinically ill with IOD, but samples from outwardly healthy individuals of the other three species were LPI positive. Serum ORP was lower in SRs compared with that in the other three species (P < 0.001), and iron chelation only reduced ORP in the GOH species (P < 0.01; ~5%). Serum ORP sex bias was revealed in three species with males exhibiting higher ORP than females (P < 0.001), the exception being the SR in which ORP was low for both sexes. ORP was not associated with age or serum iron concentrations (P ≥ 0.05), but was positively correlated with ferritin (P < 0.01). The disconnect between LPI and IOD was unanticipated, and LPI cannot be recommended as a biomarker of advanced rhino IOD. However, data provide valuable insight into the complex puzzle of rhinoceros IOD.
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Affiliation(s)
- Terri L Roth
- Corresponding author: Center for Conservation and Research of Endangered Wildlife (CREW), Cincinnati Zoo & Botanical Garden, 3400 Vine Street, Cincinnati, OH 45220, USA. Tel: 513-569-8220.
| | - Megan Philpott
- Center for Conservation and Research of Endangered Wildlife (CREW), Cincinnati Zoo & Botanical Garden, 3400 Vine Street, Cincinnati, OH 45220 USA
| | - Jessye Wojtusik
- Center for Conservation and Research of Endangered Wildlife (CREW), Cincinnati Zoo & Botanical Garden, 3400 Vine Street, Cincinnati, OH 45220 USA
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22
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Nashwan AJ, Yassin MA, Mohamed Ibrahim MI, Abdul Rahim HF, Shraim M. Iron Overload in Chronic Kidney Disease: Less Ferritin, More T2 *MRI. Front Med (Lausanne) 2022; 9:865669. [PMID: 35386917 PMCID: PMC8977522 DOI: 10.3389/fmed.2022.865669] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/25/2022] [Indexed: 01/08/2023] Open
Abstract
To date, there is no consensus on the most reliable marker of iron status in patients with chronic kidney disease (CKD). Serum ferritin is used routinely, although it may be a misleading marker for iron overload. The success of T2* MRI in monitoring iron overload in patients with hemoglobinopathies can be beneficial to monitoring patients with CKD.
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Affiliation(s)
- Abdulqadir J Nashwan
- Department of Nursing, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A Yassin
- Hematology and Oncology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Hanan F Abdul Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Mujahed Shraim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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23
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Alessandrino F, Cantisani V. Acoustic radiation force impulse elastography for liver iron overload in β-thalassemia major: Is it going to cut it? JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:117-118. [PMID: 35043443 DOI: 10.1002/jcu.23104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Affiliation(s)
| | - Vito Cantisani
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Rome, Italy
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24
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Yoshikawa M, Kudo K, Harada T, Harashima K, Suzuki J, Ogawa K, Fujiwara T, Nishida M, Sato R, Shirai T, Bito Y. Quantitative Susceptibility Mapping versus R2*-based Histogram Analysis for Evaluating Liver Fibrosis: Preliminary Results. Magn Reson Med Sci 2021; 21:609-622. [PMID: 34483224 DOI: 10.2463/mrms.mp.2020-0175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The staging of liver fibrosis is clinically important, and a less invasive method is preferred. Quantitative susceptibility mapping (QSM) has shown a great potential in estimating liver fibrosis in addition to R2* relaxometry. However, few studies have compared QSM analysis and liver fibrosis. We aimed to evaluate the feasibility of estimating liver fibrosis by using QSM and R2*-based histogram analyses by comparing it with ultrasound-based transient elastography and the stage of histologic fibrosis. METHODS Fourteen patients with liver disease were enrolled. Data sets of multi-echo gradient echo sequence with breath-holding were acquired on a 3-Tesla scanner. QSM and R2* were reconstructed by water-fat separation method, and ROIs were analyzed for these images. Quantitative parameters with histogram features (mean, variance, skewness, kurtosis, and 1st, 10th, 50th, 90th, and 99th percentiles) were extracted. These data were compared with the elasticity measured by ultrasound transient elastography and histological stage of liver fibrosis (F0 to F4, based on the new Inuyama classification) determined by biopsy or hepatectomy. The correlation of histogram parameters with intrahepatic elasticity and histologically confirmed fibrosis stage was examined. Texture parameters were compared between subgroups divided according to fibrosis stage. Receiver operating characteristic (ROC) analysis was also performed. P < 0.05 indicated statistical significance. RESULTS The six histogram parameters of both QSM and R2*were significantly correlated with intrahepatic elasticity. In particular, three parameters (variance, percentiles [90th and 99th]) of QSM showed high correlation (r = 0.818-0.844), whereas R2* parameters showed a moderate correlation with elasticity. Four parameters of QSM were significantly correlated with fibrosis stage (ρ = 0.637-0.723) and differentiated F2-4 from F0-1 fibrosis and F3-4 from F0-2 fibrosis with areas under the ROC curve of > 0.8, but those of R2* did not. CONCLUSION QSM may serve as a promising surrogate indicator in detecting liver fibrosis.
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Affiliation(s)
- Masato Yoshikawa
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine
| | - Kohsuke Kudo
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine.,Global Center for Biomedical Science and Engineering, Hokkaido University Faculty of Medicine
| | - Taisuke Harada
- Center for Cause of Death Investigation, Hokkaido University Faculty of Medicine.,Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
| | - Kazutaka Harashima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
| | - Jun Suzuki
- Department of Radiation Oncology, Hakodate Municipal Hospital
| | - Koji Ogawa
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine
| | - Taro Fujiwara
- Department of Radiology, Division of Medical Imaging and Technology, Hokkaido University Hospital
| | - Mutsumi Nishida
- Diagnostic Center for Sonography, Hokkaido University Hospital
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25
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A Retrospective Long-Term Study on Age at Menarche and Menstrual Characteristics in 85 Young Women with Transfusion-Dependent β-Thalassemia (TDT). Mediterr J Hematol Infect Dis 2021; 13:e2021040. [PMID: 34276909 PMCID: PMC8265331 DOI: 10.4084/mjhid.2021.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/04/2021] [Indexed: 12/02/2022] Open
Abstract
Background Menarche is an important milestone in a feminine reproductive life, and regular menstrual cycles reflect normal functioning of the hypothalamic-pituitary-ovarian axis, a vital sign of women’s general health. Aim of the study We explored the age at menarche and the following menstrual cycles characteristics among 85 unmarried Transfusion-Dependent β-Thalassemia (TDT) women, born between 1965 and 1995, concerning iron chelation therapy (ICT) with desferrioxamine (DFO) and nutritional status, assessed by body mass index (BMI). Results 53 adolescents who had begun ICT before the age of 10 years experienced menarche at 13,7 ± 1,6 years (mean ± DS), whereas 32 who began treatment after ten years experienced menarche significantly later (15.5 ± 1.9 yrs; p: 0.001). At the age of menarche: BMI-Z score (n= 67, −0,09 ±1) was inversely correlated with both age at starting ICT (r = −0,39; p = 0001) and age at menarche (−0,45, p = 0,0001). Serum ferritin levels (SF) were significantly correlated with the age at starting chelation therapy (n = 79; r = 0,34; p = 0,022). In 56 TDT adolescents who developed secondary amenorrhea (SA), the SF levels were significantly higher (4,098 ± 1,907 ng/mL) compared to 23 TDT adolescents with regular menstrual cycles (2,913±782 ng/mL; p = 0,005). Nutritional status of “thinness” at menarche was associated with a lower prevalence of subsequent regular menstrual cycles and a higher prevalence of early SA. Conclusion An early ICT in TDT patients was associated with a normal “tempo” of pubertal onset and a higher frequency of subsequent regular menstrual cycles. In TDT patients, who developed SA, a diagnosis of acquired central hypogonadism was made, mainly due to the chronic exposure to iron overload, however other potential causes linked to nutritional status, deficient levels of circulating nutrients, and the chronic disease itself cannot be fully excluded.
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26
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Pharmacological and clinical evaluation of deferasirox formulations for treatment tailoring. Sci Rep 2021; 11:12581. [PMID: 34131221 PMCID: PMC8206201 DOI: 10.1038/s41598-021-91983-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/20/2021] [Indexed: 01/19/2023] Open
Abstract
Deferasirox (DFX) is the newest among three different chelators available to treat iron overload in iron-loading anaemias, firstly released as Dispersible Tablets (DT) and more recently replaced by Film-Coated Tablets (FCT). In this retrospective observational study, pharmacokinetics, pharmacodynamics, and safety features of DFX treatment were analyzed in 74 patients that took both formulations subsequently under clinical practice conditions. Bioavailability of DFX FCT compared to DT resulted higher than expected [Cmax: 99.5 (FCT) and 69.7 (DT) μMol/L; AUC: 1278 (FCT) and 846 (DT), P < 0.0001]. DFX FCT was also superior in scalability among doses. After one year of treatment for each formulation, no differences were observed between the treatments in the overall iron overload levels; however, DFX FCT but not DT showed a significant dose–response correlation [Spearman r (dose-serum ferritin variation): − 0.54, P < 0.0001]. Despite being administered at different dosages, the long-term safety profile was not different between formulations: a significant increase in renal impairment risk was observed for both treatments and it was reversible under strict monitoring (P < 0.002). Altogether, these data constitute a comprehensive comparison of DFX formulations in thalassaemia and other iron-loading anaemias, confirming the effectiveness and safety characteristics of DFX and its applicability for treatment tailoring.
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27
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MRI-based R2* mapping in patients with suspected or known iron overload. Abdom Radiol (NY) 2021; 46:2505-2515. [PMID: 33388804 DOI: 10.1007/s00261-020-02912-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE R2* relaxometry is a quantitative method for assessment of iron overload. The purpose is to analyze the cross-sectional relationships between R2* in organs across patients with primary and secondary iron overload. Secondary analyses were conducted to analyze R2* according to treatment regimen. METHODS This is a retrospective, cross-sectional, institutional review board-approved study of eighty-one adult patients with known or suspected iron overload. R2* was measured by segmenting the liver, spleen, bone marrow, pancreas, renal cortex, renal medulla, and myocardium using breath-hold multi-echo gradient-recalled echo imaging at 1.5 T. Phlebotomy, transfusion, and chelation therapy were documented. Analyses included correlation, Kruskal-Wallis, and post hoc Dunn tests. p < 0.01 was considered significant. RESULTS Correlations between liver R2* and that of the spleen, bone marrow, pancreas, and heart were respectively 0.49, 0.33, 0.27, and 0.34. R2* differed between patients with primary and secondary overload in the liver (p < 0.001), spleen (p < 0.001), bone marrow (p < 0.01), renal cortex (p < 0.001), and renal medulla (p < 0.001). Liver, spleen, and bone marrow R2* were higher in thalassemia than in hereditary hemochromatosis (all p < 0.01). Renal cortex R2* was higher in sickle cell disease than in hereditary hemochromatosis (p < 0.001) and in thalassemia (p < 0.001). Overall, there was a trend toward lower liver R2* in patients assigned to phlebotomy and higher liver R2* in patients assigned to transfusion and chelation therapy. CONCLUSION R2* relaxometry revealed differences in degree or distribution of iron overload between organs, underlying etiologies, and treatment.
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28
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Lidén M, Adrian D, Widell J, Uggla B, Thunberg P. Quantitative T2* imaging of iron overload in a non-dedicated center - Normal variation, repeatability and reader variation. Eur J Radiol Open 2021; 8:100357. [PMID: 34095355 PMCID: PMC8167145 DOI: 10.1016/j.ejro.2021.100357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/03/2021] [Accepted: 05/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Patients with transfusion dependent anemia are at risk of complications from iron overload. Quantitative T2* magnetic resonance imaging (MRI) is the best non-invasive method to assess iron deposition in the liver and heart and to guide chelation therapy. Purpose To investigate the image quality and inter-observer variations in T2* measurements of the myocardium and the liver, and to obtain the lower limit of cardiac and hepatic quantitative T2* values in patients without suspicion of iron overload. Material and methods Thirty-eight patients referred for cardiac MRI were prospectively included in the study. Three patients were referred with, and 35 without suspicion of iron overload. Quantitative T2* parametric maps were obtained on a 1.5 T MRI system in the cardiac short axis and liver axial view. Two readers independently assessed the image quality and the representative and the lowest T2* value in the myocardium and the liver. Results The normal range of representative T2* values in the myocardium and liver was 24−45 ms and 14−37 ms, respectively. None of the 35 participants (0 %, 95 % confidence interval 0–11 %) in the normal reference group demonstrated representative T2* values below previously reported lower limits in the myocardium (20 ms) or the liver (8 ms). Focal myocardial areas with T2* values near the lower normal range, 19−20 ms, were seen in two patients. The readers generally reported good image quality. Conclusion T2* imaging for assessing iron overload can be performed in a non-dedicated center with sufficient image quality.
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Affiliation(s)
- Mats Lidén
- Department of Radiology, Faculty of Medicine and Health, Örebro University, S-701 82, Sweden
- Corresponding author.
| | - David Adrian
- Department of Radiology, Örebro University Hospital, Region Örebro County, Sweden
| | - Jonas Widell
- Department of Radiology, Örebro University Hospital, Region Örebro County, Sweden
| | - Bertil Uggla
- Department of Medicine, Faculty of Medicine and Health, Örebro University, Sweden
| | - Per Thunberg
- Department of Medical Physics, Faculty of Medicine and Health, Örebro University, Sweden
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29
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Hyperferritinemia-A Clinical Overview. J Clin Med 2021; 10:jcm10092008. [PMID: 34067164 PMCID: PMC8125175 DOI: 10.3390/jcm10092008] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 02/07/2023] Open
Abstract
Ferritin is one of the most frequently requested laboratory tests in primary and secondary care, and levels often deviate from reference ranges. Serving as an indirect marker for total body iron stores, low ferritin is highly specific for iron deficiency. Hyperferritinemia is, however, a non-specific finding, which is frequently overlooked in general practice. In routine medical practice, only 10% of cases are related to an iron overload, whilst the rest is seen as a result of acute phase reactions and reactive increases in ferritin due to underlying conditions. Differentiation of the presence or absence of an associated iron overload upon hyperferritinemia is essential, although often proves to be complex. In this review, we have performed a review of a selection of the literature based on the authors’ own experiences and assessments in accordance with international recommendations and guidelines. We address the biology, etiology, and epidemiology of hyperferritinemia. Finally, an algorithm for the diagnostic workup and management of hyperferritinemia is proposed, and general principles regarding the treatment of iron overload are discussed.
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30
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Lobbes H, Mahévas M, Alviset S, Galicier L, Costedoat-Chalumeau N, Amoura Z, Alric L, Hot A, Durupt S, Michel M, Godeau B. Pure red cell aplasia in systemic lupus erythematosus, a nationwide retrospective cohort and review of the literature. Rheumatology (Oxford) 2021; 61:355-366. [PMID: 33871586 DOI: 10.1093/rheumatology/keab363] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To characterize the clinical and biological course, management and response to treatment in Systemic Lupus Erythematosus (SLE)-associated Pure Red Cell Aplasia (PRCA). METHODS Nationwide multicentre retrospective cohort study. From 2006 to 2018, we included adults with a diagnosis of PRCA supported by bone-marrow examination and SLE or biologic manifestations of SLE after ruling out parvovirus B19 infection. RESULTS We enrolled 24 patients (20 women). SLE was diagnosed before PRCA for 14 patients (median delay 81 months). At PRCA diagnosis, mean age, haemoglobin level and reticulocyte and differential erythroblast count were 39.2 ± 13.2 years, 62 ± 20 g/L, 9.1 ± 7.6 x 109/L and 2.8 ± 2.5%, respectively. Eleven (45%) patients experienced multiple PRCA flares (median 6, range: 2-11). Corticosteroid therapy resulted in only three complete sustained responses, and 19 (79%) patients required immunosuppressive agents with highly variable regimens. After a median follow-up of 76 months (range 13-173), 17 (71%) patients showed complete response for PRCA, five (21%) partial response and two (8%) treatment failure. In total, 21 (87%) patients required red-blood-cell transfusion; five had a diagnosis of transfusion-related iron overload. Eighteen (75%) patients experienced severe infectious events requiring hospitalization. CONCLUSION SLE-associated PRCA is a severe condition. Repeated red-blood-cell transfusions and several lines of immunosuppressant therapy are mostly required with high risk of severe infectious events and iron overload. Despite sustained response for PRCA and SLE obtained in most patients, the best therapeutic strategy remains to be determined.
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Affiliation(s)
- Hervé Lobbes
- Service de Médecine Interne, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, France.,Service de médecine Interne, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Matthieu Mahévas
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France.,Institut Necker Enfants Malades, INSERM U1151/CNRS UMS 8253, Université Paris Descartes, Sorbonne Paris Cité, 75993 Paris Cedex 14, France.,IMRB - U955 - INSERM Equipe n°2 "Transfusion et maladies du globule rouge" EFS Île-de-France, Hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, Créteil, France
| | - Sophie Alviset
- Equipe mobile d'infectiologie, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Lionel Galicier
- Department of Clinical Immunology, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nathalie Costedoat-Chalumeau
- Department of internal medicine, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Zahir Amoura
- Service de médecine interne 2, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Alric
- Service de médecine interne, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Arnaud Hot
- Internal Medicine Department, Edouard Herriot University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Stéphane Durupt
- Service de médecine Interne, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Marc Michel
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France.,IMRB - U955 - INSERM Equipe n°2 "Transfusion et maladies du globule rouge" EFS Île-de-France, Hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, Créteil, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre National de Référence des Cytopénies Auto-Immunes de l'Adulte, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France.,IMRB - U955 - INSERM Equipe n°2 "Transfusion et maladies du globule rouge" EFS Île-de-France, Hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, Créteil, France
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DivakarJose RR, Delhikumar CG, Ram Kumar G. Efficacy and Safety of Combined Oral Chelation with Deferiprone and Deferasirox on Iron Overload in Transfusion Dependent Children with Thalassemia - A Prospective Observational Study. Indian J Pediatr 2021; 88:330-335. [PMID: 32661609 DOI: 10.1007/s12098-020-03442-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/26/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To assess the efficacy and safety of dual oral iron chelation therapy (deferiprone and deferasirox) in decreasing iron overload status, using serum ferritin and liver and cardiac MRI as indicators, in transfusion dependent thalassemic children. METHODS This was a prospective observational study conducted in a tertiary care hospital for a period of one year. Children with thalassemia between 2 and 18 y of age with serum ferritin above 1500 ng/ml were started on oral deferiprone and deferasirox. They were followed up for one year. Serum ferritin and MRI quantification of liver and cardiac iron concentration was done at enrolment and end of 12 mo. They were also monitored monthly for any adverse effects. RESULTS Twenty one thalassemic children with mean age of 7.8 y (range 4-12 y) and a mean ferritin value of 3129 + 1231.5 ng/ml were enrolled. Mean serum ferritin decreased by 1226.3 ng/ml (p = 0.047, 95% CI =10.2, 1504.3) with 16.8% fall from baseline. The reduction in ferritin correlated significantly with the initial ferritin level (spearman's rho = 0.742, p = 0.001). Mean liver iron concentration and myocardial iron concentration did not change significantly. Red color urine, transient rise in creatinine and liver enzymes were noted during the study period. CONCLUSIONS Combined oral chelation with deferiprone and deferasirox significantly decreases the serum ferritin level in children with severe iron overload. The drugs were tolerated well without any serious adverse effects.
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Affiliation(s)
| | - C G Delhikumar
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
| | - G Ram Kumar
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Grootendorst S, de Wilde J, van Dooijeweert B, van Vuren A, van Solinge W, Schutgens R, van Wijk R, Bartels M. The Interplay between Drivers of Erythropoiesis and Iron Homeostasis in Rare Hereditary Anemias: Tipping the Balance. Int J Mol Sci 2021; 22:ijms22042204. [PMID: 33672223 PMCID: PMC7927117 DOI: 10.3390/ijms22042204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 01/19/2023] Open
Abstract
Rare hereditary anemias (RHA) represent a group of disorders characterized by either impaired production of erythrocytes or decreased survival (i.e., hemolysis). In RHA, the regulation of iron metabolism and erythropoiesis is often disturbed, leading to iron overload or worsening of chronic anemia due to unavailability of iron for erythropoiesis. Whereas iron overload generally is a well-recognized complication in patients requiring regular blood transfusions, it is also a significant problem in a large proportion of patients with RHA that are not transfusion dependent. This indicates that RHA share disease-specific defects in erythroid development that are linked to intrinsic defects in iron metabolism. In this review, we discuss the key regulators involved in the interplay between iron and erythropoiesis and their importance in the spectrum of RHA.
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Affiliation(s)
- Simon Grootendorst
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (S.G.); (J.d.W.); (B.v.D.); (W.v.S.); (R.v.W.)
| | - Jonathan de Wilde
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (S.G.); (J.d.W.); (B.v.D.); (W.v.S.); (R.v.W.)
| | - Birgit van Dooijeweert
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (S.G.); (J.d.W.); (B.v.D.); (W.v.S.); (R.v.W.)
| | - Annelies van Vuren
- Van Creveldkliniek, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (A.v.V.); (R.S.)
| | - Wouter van Solinge
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (S.G.); (J.d.W.); (B.v.D.); (W.v.S.); (R.v.W.)
| | - Roger Schutgens
- Van Creveldkliniek, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (A.v.V.); (R.S.)
| | - Richard van Wijk
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (S.G.); (J.d.W.); (B.v.D.); (W.v.S.); (R.v.W.)
| | - Marije Bartels
- Van Creveldkliniek, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (A.v.V.); (R.S.)
- Correspondence:
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Löfstedt T, Hellström M, Bylund M, Garpebring A. Bayesian non-linear regression with spatial priors for noise reduction and error estimation in quantitative MRI with an application in T1 estimation. Phys Med Biol 2020; 65:225036. [PMID: 32947277 DOI: 10.1088/1361-6560/abb9f5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To develop a method that can reduce and estimate uncertainty in quantitative MR parameter maps without the need for hand-tuning of any hyperparameters. METHODS We present an estimation method where uncertainties are reduced by incorporating information on spatial correlations between neighbouring voxels. The method is based on a Bayesian hierarchical non-linear regression model, where the parameters of interest are sampled, using Markov chain Monte Carlo (MCMC), from a high-dimensional posterior distribution with a spatial prior. The degree to which the prior affects the model is determined by an automatic hyperparameter search using an information criterion and is, therefore, free from manual user-dependent tuning. The samples obtained further provide a convenient means to obtain uncertainties in both voxels and regions. The developed method was evaluated on T 1 estimations based on the variable flip angle method. RESULTS The proposed method delivers noise-reduced T 1 parameter maps with associated error estimates by combining MCMC sampling, the widely applicable information criterion, and total variation-based denoising. The proposed method results in an overall decrease in estimation error when compared to conventional voxel-wise maximum likelihood estimation. However, this comes with an increased bias in some regions, predominately at tissue interfaces, as well as an increase in computational time. CONCLUSIONS This study provides a method that generates more precise estimates compared to the conventional method, without incorporating user subjectivity, and with the added benefit of uncertainty estimation.
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Affiliation(s)
- Tommy Löfstedt
- Department of Radiation Sciences, Umeå University, Umeå, Sweden. Department of Computing Science, Umeå University, Umeå, Sweden. Equally contributing authors
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Pinto VM, Forni GL. Management of Iron Overload in Beta-Thalassemia Patients: Clinical Practice Update Based on Case Series. Int J Mol Sci 2020; 21:E8771. [PMID: 33233561 PMCID: PMC7699680 DOI: 10.3390/ijms21228771] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/14/2020] [Accepted: 11/18/2020] [Indexed: 12/29/2022] Open
Abstract
Thalassemia syndromes are characterized by the inability to produce normal hemoglobin. Ineffective erythropoiesis and red cell transfusions are sources of excess iron that the human organism is unable to remove. Iron that is not saturated by transferrin is a toxic agent that, in transfusion-dependent patients, leads to death from iron-induced cardiomyopathy in the second decade of life. The availability of effective iron chelators, advances in the understanding of the mechanism of iron toxicity and overloading, and the availability of noninvasive methods to monitor iron loading and unloading in the liver, heart, and pancreas have all significantly increased the survival of patients with thalassemia. Prolonged exposure to iron toxicity is involved in the development of endocrinopathy, osteoporosis, cirrhosis, renal failure, and malignant transformation. Now that survival has been dramatically improved, the challenge of iron chelation therapy is to prevent complications. The time has come to consider that the primary goal of chelation therapy is to avoid 24-h exposure to toxic iron and maintain body iron levels within the normal range, avoiding possible chelation-related damage. It is very important to minimize irreversible organ damage to prevent malignant transformation before complications set in and make patients ineligible for current and future curative therapies. In this clinical case-based review, we highlight particular aspects of the management of iron overload in patients with beta-thalassemia syndromes, focusing on our own experience in treating such patients. We review the pathophysiology of iron overload and the different ways to assess, quantify, and monitor it. We also discuss chelation strategies that can be used with currently available chelators, balancing the need to keep non-transferrin-bound iron levels to a minimum (zero) 24 h a day, 7 days a week and the risk of over-chelation.
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Affiliation(s)
- Valeria Maria Pinto
- Centro della Microcitemia e delle Anemie Congenite Ente Ospedaliero Ospedali Galliera, Via Volta 6, 16128 Genoa, Italy;
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Abstract
Iron overload is a common clinical problem resulting from hereditary hemochromatosis or secondary hemosiderosis (mainly associated with transfusion therapy), being also associated with chronic liver diseases and metabolic disorders. Excess of iron accumulates in organs like the liver, pancreas and heart. Without treatment, patients with iron overload disorders will develop liver cirrhosis, diabetes and cardiomyopathy. Iron quantification is therefore crucial not only for diagnosis of iron overload but also to monitor iron-reducing therapies. Liver iron concentration is considered the surrogate marker of total body iron stores. Because liver biopsy is invasive and prone to high variability and sampling bias, MR imaging has emerged as a non-invasive method and gained wide acceptance, now being considered the standard of care for assessing iron overload. Nevertheless, there are different MR techniques for iron quantification and there is still no consensus about the best technique or postprocessing tool for hepatic iron quantification, with the choice of imaging technique depending mainly on the local expertise as well on the available equipment and software. Because different methods should not be used interchangeably, it is important to choose one method and use the same one when following up patients over time.
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Affiliation(s)
- Manuela França
- Radiology Department - Centro Hospitalar Universitário do Porto, Largo Prof Abel Salazar, 4099-001, Porto, Portugal.
- Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, I3S, Instituto de Investigação e Inovação em Saúde, Porto, Portugal.
| | - João Gomes Carvalho
- Radiology Department - Centro Hospitalar Universitário do Porto, Largo Prof Abel Salazar, 4099-001, Porto, Portugal
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Iorember F, Aviles D, Bamgbola O. Impact of immediate post-transplant parenteral iron therapy on the prevalence of anemia and short-term allograft function in a cohort of pediatric and adolescent renal transplant recipients. Pediatr Transplant 2020; 24:e13787. [PMID: 32678506 DOI: 10.1111/petr.13787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/14/2020] [Accepted: 06/16/2020] [Indexed: 12/29/2022]
Abstract
Anemia is common but under-diagnosed and often inadequately treated in KTX recipients. ID is the major cause of early-onset anemia. We introduced routine use of parenteral (IV) iron in patients (2-18 years) who had KTX between January 2011 and December 2015. We explored the clinical benefits of this practice by comparing the iron-treated subjects [TX] with historical controls who had KTX between 2005 and 2010. The prevalence of anemia at 6 months (early-onset) for the cohort (both the study group and controls) was 55% and for anemia at 12 months (late-onset) was 60%. Although cause-effect relationship may not be proven in a retrospective study design, there was a significant greater frequency of ID and anemia at 3 (P < .02) and 6 months (P < .04), and a reduced allograft function (eGFR < 60 mL/min/1.73 m2 ) at 12 (P = .03) and 24 months (P = .04) of KTX in the control arm. Furthermore, a greater proportion of the control arm required either ESA (P = .03) or blood transfusion (P = .04) as a rescue treatment for moderate-to-severe anemia. In conclusion, routine parenteral iron treatment was associated with a lower prevalence of early- and late-onset anemia, and a lower requirement for either ESA rescue or blood transfusion.
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Affiliation(s)
- Franca Iorember
- Division of Pediatric Nephrology, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Diego Aviles
- Division of Pediatric Nephrology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Oluwatoyin Bamgbola
- Division of Pediatric Nephrology, SUNY Downstate Medical Center, Brooklyn, New York, USA
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Wang Q, Xiao H, Yu X, Lin H, Yang B, Zhang Y, Feng D, Yan F, Wang H. R1ρ at high spin-lock frequency could be a complementary imaging biomarker for liver iron overload quantification. Magn Reson Imaging 2020; 75:141-148. [PMID: 33129937 DOI: 10.1016/j.mri.2020.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE To compare the correlations among the R1ρ, R2, and R2* relaxation rates with liver iron concentration (LIC) in the assessment of rat liver iron content and explore the application potential of R1ρ in assessing liver iron content. METHODS Iron dextran (dosage of 0, 25, 50, 100, and 200 mg/kg body weight) was injected into 35 male rats to increase the amount of iron storage in the liver. After one week, all rats were euthanized with isoflurane. A portion of the largest hepatic lobe was extracted to quantify the LIC by inductively coupled plasma, and the remaining liver tissue was stored in 4% buffered paraformaldehyde for 24 h before MRI. Spin-lock preparation with a RARE (rapid acquisition with relaxation enhancement) readout (9 different spin-lock times and 7 different spin-lock frequencies (FSLs)) and multi-echo UTE (ultrashort TE) pulses were developed to quantify R1ρ and R2 * on a Bruker 11.7 T MR system. For comparisons with R1ρ and R2*, R2 was acquired using the CPMG sequence. RESULTS Mean R1ρ values displayed dispersion, with decrease in R1ρ at higher FSLs. Spearman's correlation analysis (two-tailed) indicated that the R1ρ values were significantly associated with LIC at FSL = 2000, 2500, and 3000 Hz (r = 0.365 and P = 0.031, r = 0.608 and P < 0.001, and r = 0.764 and P < 0.001, respectively), and were not significantly associated with LIC at FSL = 500, 1000, 1250, and 1500 Hz (all P > 0.05). R2 and R2* showed significant linear correlations with LIC (r = 0.787 and P < 0.001, and r = 0.859 and P < 0.001, respectively). Correlation analysis across R1ρ, R2, and R* also suggested that the correlation strength between R1ρ and R2 and between R1ρ and R* showed an increasing trend with increase in FSL. CONCLUSION In this study, a strong association was observed between R1ρ and LIC at high FSLs further confirming previous findings. The results demonstrated that R1ρ at high FSL might serve as a complementary imaging biomarker for liver iron overload quantification.
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Affiliation(s)
- Qianfeng Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Hong Xiao
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuchen Yu
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Huimin Lin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Baofeng Yang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Yuwen Zhang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Danyang Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - He Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Human Phenome Institute, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China.
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Sullivan KE, Mylniczenko ND, Nelson SE, Coffin B, Lavin SR. Practical Management of Iron Overload Disorder (IOD) in Black Rhinoceros (BR; Diceros bicornis). Animals (Basel) 2020; 10:ani10111991. [PMID: 33138144 PMCID: PMC7692874 DOI: 10.3390/ani10111991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Black rhinoceros under human care are predisposed to Iron Overload Disorder that is unlike the hereditary condition seen in humans. We aim to address the black rhino caretaker community at multiple perspectives (keeper, curator, veterinarian, nutritionist, veterinary technician, and researcher) to describe approaches to Iron Overload Disorder in black rhinos and share learnings. This report includes sections on (1) background on how iron functions in comparative species and how Iron Overload Disorder appears to work in black rhinos, (2) practical recommendations for known diagnostics, (3) a brief review of current investigations on inflammatory and other potential biomarkers, (4) nutrition knowledge and advice as prevention, and (5) an overview of treatment options including information on chelation and details on performing large volume voluntary phlebotomy. The aim is to use evidence to support the successful management of this disorder to ensure optimal animal health, welfare, and longevity for a sustainable black rhinoceros population. Abstract Critically endangered black rhinoceros (BR) under human care are predisposed to non-hemochromatosis Iron Overload Disorder (IOD). Over the last 30 years, BR have been documented with diseases that have either been induced by or exacerbated by IOD, prompting significant efforts to investigate and address this disorder. IOD is a multi-factorial chronic disease process requiring an evidence-based and integrative long-term approach. While research continues to elucidate the complexities of iron absorption, metabolism, and dysregulation in this species, preventive treatments are recommended and explained herein. The aim of this report is to highlight the accumulated evidence in nutrition, clinical medicine, and behavioral husbandry supporting the successful management of this disorder to ensure optimal animal health, welfare, and longevity for a sustainable black rhinoceros population.
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Chan LKL, Mak VWM, Chan SCH, Yu ELM, Chan NCN, Leung KFS, Ng CKM, Ng MHL, Chan JCW, Lee HKK. Liver complications of haemoglobin H disease in adults. Br J Haematol 2020; 192:171-178. [PMID: 33095929 DOI: 10.1111/bjh.17115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/27/2020] [Indexed: 12/15/2022]
Abstract
Haemoglobin H (HbH) disease is a type of non-transfusion-dependent thalassaemia. This cross-sectional study aimed at determining the prevalence and severity of liver iron overload and liver fibrosis in patients with HbH disease. Risk factors for advanced liver fibrosis were also identified. A total of 80 patients were evaluated [median (range) age 53 (24-79) years, male 34%, non-deletional HbH disease 24%]. Patients underwent 'observed' T2-weighted magnetic resonance imaging examination for liver iron concentration (LIC) quantification, and transient elastography for liver stiffness measurement (LSM) and fibrosis staging. In all, 25 patients (31%) had moderate-to-severe liver iron overload (LIC ≥7 mg/g dry weight). The median LIC was higher in non-deletional than in deletional HbH disease (7·8 vs. 2.9 mg/g dry weight, P = 0·002). In all, 16 patients (20%) had advanced liver fibrosis (LSM >7.9 kPa) and seven (9%) out of them had probable cirrhosis (LSM >11.9 kPa). LSM positively correlated with age (R = 0·24, P = 0·03), serum ferritin (R = 0·36, P = 0·001) and LIC (R = 0·28, P = 0·01). In multivariable regression, age ≥65 years [odds ratio (OR) 4·97, 95% confidence interval (CI) 1·52-17·50; P = 0·047] and moderate-to-severe liver iron overload (OR 3·47, 95% CI 1·01-12·14; P = 0·01) were independently associated with advanced liver fibrosis. The findings suggest that regular screening for liver complications should be considered in the management of HbH disease.
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Affiliation(s)
- Luke K L Chan
- Division of Haematology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Vivien W M Mak
- Division of Haematology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Stanley C H Chan
- Department of Radiology, Princess Margaret Hospital, Hong Kong, China
| | - Ellen L M Yu
- Clinical Research Centre, Princess Margaret Hospital, Hong Kong, China
| | - Nelson C N Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Kate F S Leung
- Division of Haematology, Department of Pathology, Princess Margaret Hospital, Hong Kong, China
| | - Carmen K M Ng
- Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Margaret H L Ng
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Joyce C W Chan
- Division of Haematology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Harold K K Lee
- Division of Haematology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
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40
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Economic Evaluation of Severe Anaemia: Review-Based Recommendations and a Conceptual Framework. EUROPEAN MEDICAL JOURNAL 2020. [DOI: 10.33590/emj/20-00102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective: Novel anaemia treatments have greatly improved patient outcomes in the last decade and have also undergone economic evaluations in various settings using heterogenous model structures, costs, and inputs. The objectives were to review published economic evaluation studies in major red blood cell disorders, identify limitations in the applied methodology, provide a set of recommendations, and produce a conceptual framework for future economic research in this disease area.
Methods: A targeted search was conducted for economic literature evaluating treatments in major red blood cell disorders related to anaemia. Disorders included autoimmune haemolytic anaemia, β-thalassaemia, chemotherapy-induced anaemia, anaemia in chronic kidney disease, and severe aplastic anaemia. Budget impact models and cost-effectiveness and cost-utility analyses were considered. Modelling assumptions regarding the model structure, time horizon, perspective, and type of costs were reviewed and recommendations and a conceptual framework for future economic analyses were created.
Results: A total of four budget impact models, nine cost-utility analyses, and four cost-effectiveness analyses were investigated. A major limitation was that the included costs varied significantly across studies. Costs which were rarely included, and generally should be considered, were related to adverse events, mortality, and productivity. Additionally, relationships between levels of serum ferritin, hepatic or total body iron, and haemoglobin with long-term complications and mortality were rarely included.
Conclusion: Published economic analyses evaluating treatments for major red blood cell disorders frequently exclude vital costs. A set of recommendations and a conceptual framework will aid researchers in applying a more comprehensive approach for economic evaluations in major red blood cell disorders.
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Should we use ferritin in the diagnostic criteria of iron deficiency in heart failure patients? Clin Nutr ESPEN 2020; 39:119-123. [PMID: 32859304 DOI: 10.1016/j.clnesp.2020.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Iron deficiency (ID) is a common comorbidity in patients with chronic heart failure (HF) and is associated with worse prognosis. We aimed at comparing the currently European Society of Cardiology (ESC) criterion for diagnosis of ID (ferritin < 100 μg/L or ferritin 100-299 μg/L with transferrin saturation [TSAT] < 20%) with either isolated low TSAT or isolated low ferritin on survival, in a cohort of HF patients. METHODS This was an observational prospective study, investigating ambulatory patients with HF and reduced ejection fraction (n = 108). All patients were assessed for clinical aspects and iron indexes. The primary endpoint was all-cause death. RESULTS Abnormal iron status was observed in 50 (46%) of patients. During the median follow-up time of 857.5 [647-899] days, 31 patients died (29%). In univariate analyses ESC-criterion (p = 0.022) and isolated TSAT <20% (p = 0.002), but not isolated ferritin <100 μg/L (p = 0.439), were significantly related to an increased risk of all-cause death. However, in multivariate analyses only TSAT <20% (HR = 2.3; [95% CI: 1.11-4.85]; p = 0.026) was independently related to all-cause mortality. CONCLUSIONS Our results indicated that diagnosis of ID based on isolated TSAT <20% identifies HF patients with worse prognosis, while ferritin was not associated with mortality risk, suggesting that ferritin should not be taken into account for evaluation of clinical impact of ID in HF patients.
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Grzeszczak K, Kwiatkowski S, Kosik-Bogacka D. The Role of Fe, Zn, and Cu in Pregnancy. Biomolecules 2020; 10:E1176. [PMID: 32806787 PMCID: PMC7463674 DOI: 10.3390/biom10081176] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022] Open
Abstract
Iron (Fe), copper (Cu), and zinc (Zn) are microelements essential for the proper functioning of living organisms. These elements participatein many processes, including cellular metabolism and antioxidant and anti-inflammatory defenses, and also influence enzyme activity, regulate gene expression, and take part in protein synthesis. Fe, Cu, and Zn have a significant impact on the health of pregnant women and in the development of the fetus, as well as on the health of the newborn. A proper concentration of these elements in the body of women during pregnancy reduces the risk of complications such as anemia, induced hypertension, low birth weight, preeclampsia, and postnatal complications. The interactions between Fe, Cu, and Zn influence their availability due to their similar physicochemical properties. This most often occurs during intestinal absorption, where metal ions compete for binding sites with transport compounds. Additionally, the relationships between these ions have a great influence on the course of reactions in the tissues, as well as on their excretion, which can be stimulated or delayed. This review aims to summarize reports on the influence of Fe, Cu, and Zn on the course of single and multiple pregnancies, and to discuss the interdependencies and mechanisms occurring between Fe, Cu, and Zn.
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Affiliation(s)
- Konrad Grzeszczak
- Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Sebastian Kwiatkowski
- Department of Obstetrics and Gynecology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Danuta Kosik-Bogacka
- Independent Laboratory of Pharmaceutical Botany, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
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Strategies for managing transfusional iron overload: conventional treatments and novel strategies. Curr Opin Hematol 2020; 26:139-144. [PMID: 30855336 DOI: 10.1097/moh.0000000000000499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW For individuals who have transfusion-dependent anemia, iron overload is the long-term complication, which results in significant morbidity. Ameliorating this is now the biggest unmet need. This review specifically addresses this issue. RECENT FINDINGS Over the last decade or so, major advances in the treatment of these individuals, has resulted from novel strategies aimed at reducing transfusion requirement as well as optimizing chelation therapy. This review will summarize these advances and provide insights into some of the therapies in the pipeline. Strategies aimed at reducing transfusion requirement include modulation of erythropoietic regulation by reducing ineffective red cell production through activin trapping, as well as stem cell gene modification approaches, which aim for a cure, and transfusion independence. Refined means of assessing tissue iron and the introduction of oral chelators have facilitated tailoring chelation regimens with closer monitoring and improved compliance. Newer approaches to ameliorate iron toxicity have focused on the hepcidin pathway, all of which would result in increased hepcidin levels and reduction of iron absorption from the intestine, sequestration of iron in normal storage sites and reduced exposure of more susceptible organs, such as the heart and endocrine organs, to the toxic effects of increased iron. SUMMARY These advances offer the promise of improved management of transfusion-dependent individuals.
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Caocci G, Vignetti M, Patriarca A, Breccia M, Platzbecker U, Palumbo GA, Stauder R, Cottone F, Petranovic D, Voso MT, Tafuri A, Invernizzi R, Caers J, Luppi M, La Nasa G, Niscola P, Efficace F. High serum ferritin levels in newly diagnosed patients with myelodysplastic syndromes are associated with greater symptom severity. Int J Hematol 2020; 112:141-146. [PMID: 32588394 DOI: 10.1007/s12185-020-02920-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 11/27/2022]
Abstract
We examined the association between serum ferritin (SF) levels and patient-reported functional aspects and symptoms, as measured by the EORTC QLQ-C30, in newly diagnosed patients with myelodysplastic syndromes (MDS). Analysis was conducted on 497 MDS patients who were classified in two groups based on the SF value of 1000 ng/mL. Clinically relevant differences of patient-reported functional and symptom scales were evaluated and classified as small, medium and large, based on established thresholds. Multivariable linear regression analysis was performed to account for potential confounding factors. Patients with SF of ≥ 1000 ng/mL reported statistically significant and clinically relevant worse outcomes across various health domains. Dyspnea was the symptom indicating the largest difference and mean scores of patients with higher and lower SF levels were 40 and 24.3, respectively (p = 0.005), indicating a large clinically relevant difference (Δ = 15.7). Further research is needed to better understand the relationship between SF levels and specific health-related quality of life domains.
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Affiliation(s)
- Giovanni Caocci
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Marco Vignetti
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), Rome, Italy
| | - Andrea Patriarca
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Massimo Breccia
- Department of Cellular Biotechnologies and Hematology, Division of Hematology, Sapienza University, Rome, Italy
| | - Uwe Platzbecker
- Clinic and Policlinic of Hematology and Cellular Therapy, Oncology and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - Giuseppe A Palumbo
- Dipartimento di Scienze Mediche, Chirurgiche E Tecnologie Avanzate "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Reinhard Stauder
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Francesco Cottone
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), Rome, Italy
| | - Duska Petranovic
- Department of Hematology, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, Università di Roma "Tor Vergata", Rome, Italy
| | | | - Rosangela Invernizzi
- Department of Internal Medicine, San Matteo IRCCS Policlinic Foundation, University of Pavia, Pavia, Italy
| | - Jo Caers
- Department of Hematology, CHU de Liège, University of Liege, Liege, Belgium
| | - Mario Luppi
- Department of Medical and Surgical Sciences, Chair of Hematology, AOU Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Giorgio La Nasa
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Fabio Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), Rome, Italy.
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Low risk of iron overload or anaphylaxis during treatment of restless legs syndrome with intravenous iron: a consecutive case series in a regular clinical setting. Sleep Med 2020; 74:48-55. [PMID: 32841843 DOI: 10.1016/j.sleep.2020.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/21/2020] [Accepted: 06/01/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the incidence of iron overload and anaphylaxis following intravenous (IV) iron treatment of restless legs syndrome (RLS). METHODS A total of 58 consecutive RLS patients, meeting clinical requirements for IV iron treatment according to current IRLSSG guidelines were recruited. IV iron treatment consisted of two 500 mg infusions of ferric carboxymaltose (FCM) administered five days apart. During each of the three follow-up visits we obtained blood samples, substantia nigra echogenity index (SNEI) by means of transcranial sonography (TCS), and assessed the severity of RLS symptoms (IRLS scale). "Iron overload risk" was defined as transferrin saturation (TSAT) > 45% on two consecutive follow-up visits. In patients who had a reduction in systemic iron levels following treatment, an additional 500 mg of FCM was administered when feasible. In such cases an additional two follow-up visits were performed. RESULTS Among the total sample, only 2/58 participants met criteria for iron overload risk. They had no evidence of liver damage and did not require additional treatment. Among the 21 patients receiving an additional 500 mg infusion after, only one patient was diagnosed with iron overload risk. Among these three patients, only one was a hemochromatosis gene carrier. No anaphylaxis or other side-effects were reported. CONCLUSIONS In real-life clinical conditions, the risk of iron overload is low when IV FCM is administered according to the safety limits defined in the current RLS treatment guidelines. However, a close clinical follow-up with periodic blood sampling for iron status, is needed.
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Acar S, Gözmen S, Bayraktaroğlu S, Acar SO, Tahta N, Aydınok Y, Vergin RC. Evaluation of Liver Iron Content by Magnetic Resonance Imaging in Children with Acute Lymphoblastic Leukemia after Cessation of Treatment. Turk J Haematol 2020; 37:263-270. [PMID: 32077272 PMCID: PMC7702656 DOI: 10.4274/tjh.galenos.2020.2019.0364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objective There are a limited number of studies evaluating iron overload in childhood leukemia by magnetic resonance imaging (MRI). The aim of this study was to determine liver iron content (LIC) by MRI in children with acute lymphoblastic leukemia (ALL) who had completed treatment and to compare those values with serum iron parameters. Materials and Methods A total of 30 patients between the ages of 7 and 18 who had completed ALL treatment were included in the study. Serum iron parameters (serum iron, serum ferritin [SF], and total iron-binding capacity) and liver function tests were studied. R2 MRI was performed for determining LIC. Results Normal LIC was detected in 22 (63.4%) of the cases. Seven (23.3%) had mild and 1 (3.3%) had moderate liver iron deposition. In contrast, severe iron overload was not detected in any of the cases. LIC levels were correlated with the numbers of packed red blood cell (pRBC) transfusions (r=0.637, p<0.001), pRBC transfusion volume (r=0.449, p<0.013), SF levels (r=0.561, p=0.001), and transferrin saturation (r=0.353, p=0.044). In addition, a positive correlation was found between the number of pRBC transfusions and SF levels (r=0.595, p<0.001). Conclusion We showed that the frequency of liver iron deposition was low and clinically less significant after the end of treatment in childhood ALL patients. LIC was demonstrated to be related to SF and transfusion history. These findings support that SF and transfusion history may be used as references for monitoring iron accumulation or identifying cases for further examinations such as MRI.
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Affiliation(s)
- Sezer Acar
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatrics, İzmir, Turkey
| | - Salih Gözmen
- Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Division of Pediatric Hematology and Oncology, İzmir, Turkey
| | | | - Sultan O. Acar
- Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Division of Pediatric Hematology and Oncology, İzmir, Turkey
| | - Neryal Tahta
- Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Division of Pediatric Hematology and Oncology, İzmir, Turkey
| | - Yeşim Aydınok
- Ege University Faculty of Medicine, Division of Pediatric Hematology and Oncology, İzmir, Turkey
| | - Raziye C. Vergin
- Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Division of Pediatric Hematology and Oncology, İzmir, Turkey
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Nava T, Ansari M, Dalle JH, de Heredia CD, Güngör T, Trigoso E, Falkenberg U, Bertaina A, Gibson B, Jarisch A, Balduzzi A, Boenig H, Krivan G, Vettenranta K, Matic T, Buechner J, Kalwak K, Lawitschka A, Yesilipek A, Lucchini G, Peters C, Turkiewicz D, Niinimäki R, Diesch T, Lehrnbecher T, Sedlacek P, Hutt D, Dalissier A, Wachowiak J, Yaniv I, Stein J, Yalçin K, Sisinni L, Deiana M, Ifversen M, Kuhlen M, Meisel R, Bakhtiar S, Cesaro S, Willasch A, Corbacioglu S, Bader P. Supportive care during pediatric hematopoietic stem cell transplantation: beyond infectious diseases. A report from workshops on supportive care of the Pediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant 2020; 55:1126-1136. [PMID: 32029909 DOI: 10.1038/s41409-020-0818-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 01/15/2020] [Accepted: 01/28/2020] [Indexed: 12/16/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) is currently the standard of care for many malignant and nonmalignant blood diseases. As several treatment-emerging acute toxicities are expected, optimal supportive measurements critically affect HSCT outcomes. The paucity of good clinical studies in supportive practices gives rise to the establishment of heterogeneous guidelines across the different centers, which hampers direct clinical comparison in multicentric studies. Aiming to harmonize the supportive care provided during the pediatric HSCT in Europe, the Pediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT) promoted dedicated workshops during the years 2017 and 2018. The present paper describes the resulting consensus on the management of sinusoidal obstructive syndrome, mucositis, enteral and parenteral nutrition, iron overload, and emesis during HSCT.
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Affiliation(s)
- Tiago Nava
- Division of Pediatric Hematology-Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Marc Ansari
- Division of Pediatric Hematology-Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Jean-Hugues Dalle
- Hematology and Immunology Department, Robert-Debre Hospital, Assistance Publique-Hopitaux de Paris & University of Paris, Paris, France
| | - Christina Diaz de Heredia
- Department of Pediatric Oncology and Hematology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Tayfun Güngör
- Department of Hematology, Immunology, Oncology and Stem Cell Transplantation, University Children's Hospital Zürich, Zürich, Switzerland
| | - Eugenia Trigoso
- Paediatric Transplant Unit, Hospital University and Polytechnic Hospital LA FE, Valencia, Spain
| | - Ulrike Falkenberg
- SCT-Unit, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Alice Bertaina
- Department of Pediatric Hematology/Oncology and Cell and Gene Therapy, IRCCS, Ospedale Bambino Gesù, Rome, Italy
| | - Brenda Gibson
- Department of Paediatric Haematology-Oncology, Royal Hospital for Children, Glasgow, Scotland, UK
| | - Andrea Jarisch
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Adriana Balduzzi
- Clinica Pediatrica Università degli Studi di Milano Bicocca, Fondazione MBBM, Ospedale San Gerardo, Monza, Italy
| | - Halvard Boenig
- Institute for Transfusion Medicine and Immunohematology of Goethe University and German Red Cross Blood Service Baden-Württemberg-Hessen, Frankfurt/Main, Germany
| | - Gergely Krivan
- Central Hospital of Southern Pest, National Institute of Hematology and Infectious Disease, Budapest, Hungary
| | - Kim Vettenranta
- Children's Hospital, and Pediatric Research Center, University of Helsinki, Helsinki, Finland
| | - Toni Matic
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Jochen Buechner
- Department of Pediatric Hematology and Oncology, Oslo University Hospital, Oslo, Norway
| | - Krzysztof Kalwak
- Department of Pediatric Hematology, Oncology and BMT, Wroclaw Medical University, Wroclaw, Poland
| | - Anita Lawitschka
- SCT-Unit, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Akif Yesilipek
- Department of Pediatric Hematology & Pediatric Stem Cell Transplantation Unit, Antalya & Goztepe Medicalpark Hospitals, Antalya, Turkey
| | - Giovanna Lucchini
- Department of BMT, Great Ormond Street Hospital for Children, National Health Service (NHS) Foundation Trust, London, UK
| | - Christina Peters
- SCT-Unit, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | | | - Riitta Niinimäki
- Department of Pediatrics, Oulu University Hospital, Oulu, Finland
| | - Tamara Diesch
- Division of Pediatric Hematology/Oncology, University Children's Hospital of Basel, Basel, Switzerland
| | - Thomas Lehrnbecher
- Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Petr Sedlacek
- Division of Pediatric Hematology and Oncology, Hospital Motol, Charles University, Prague, Czech Republic
| | - Daphna Hutt
- Division of Pediatric Hematology, Oncology and BMT, The Edmond and Lily Safra Children's Hospital, Tel Hashomer, Israel
| | | | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and HSCT, Poznan University of Medical Sciences, Poznań, Poland
| | - Isaac Yaniv
- Division of Pediatric Hematoloy/Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Jerry Stein
- Division of Pediatric Hematoloy/Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Koray Yalçin
- Department of Pediatric Bone Marrow Transplantation Unit, MedicalPark Göztepe Hospital, Instanbul, Turkey
| | - Luisa Sisinni
- Pediatric Hematology, Oncology and HSCT Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Marco Deiana
- Paediatric Haematology/Oncology Department, IRCCS G Gaslini, Genova, Italy
| | - Marianne Ifversen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Roland Meisel
- Division of Pediatric Stem Cell Therapy, Clinic for Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Shahrzad Bakhtiar
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Simone Cesaro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Andre Willasch
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital of Regensburg, Regensburg, Germany
| | - Peter Bader
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt am Main, Germany.
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Abstract
OBJECTIVE. A spectrum of pathophysiologic mechanisms can lead to the development of myocardial disorders including ischemia, genetic abnormalities, and systemic disorders. Cardiac MRI identifies different myocardial disorders, provides prognostic information, and directs therapy. In comparison with other imaging modalities, cardiac MRI has the advantage of allowing both functional assessment and tissues characterization in a single examination without the use of ionizing radiation. Newer cardiac MRI techniques including mapping can provide additional information about myocardial disease that may not be detected using conventional techniques. Emerging techniques including MR spectroscopy and finger printing will likely change the way we understand the pathophysiology mechanisms of the wide array of myocardial disorders. CONCLUSION. Imaging of myocardial disorders encompasses a large variety of conditions including both ischemic and nonischemic diseases. Cardiac MRI sequences, such as balanced steady-state free precession and late gadolinium enhancement, play a critical role in establishing diagnosis, determining prognosis, and guiding therapeutic management. Additional sequences-including perfusion imaging, T2*, real-time cine, and T2-weighted sequences-should be performed in specific clinical scenarios. There is emerging evidence for the use of mapping in imaging of myocardial disease. Multiple other new techniques are currently being studied. These novel techniques will likely change the way myocardial disorders are understood and diagnosed in the near future.
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Coates TD. Iron overload in transfusion-dependent patients. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:337-344. [PMID: 31808901 PMCID: PMC6913424 DOI: 10.1182/hematology.2019000036] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Before the advent of effective iron chelation, death from iron-induced cardiomyopathy occurred in the second decade in patients with transfusion-dependent chronic anemias. The advances in our understanding of iron metabolism; the ability to monitor iron loading in the liver, heart, pancreas and pituitary; and the availability of several effective iron chelators have dramatically improved survival and reduced morbidity from transfusion-related iron overload. Nevertheless, significantly increased survival brings about new complications such as malignant transformation resulting from prolonged exposure to iron, which need to be considered when developing long-term therapeutic strategies. This review discusses the current biology of iron homeostasis and its close relation to marrow activity in patients with transfusion-dependent anemias, and how biology informs clinical approach to treatment.
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Affiliation(s)
- Thomas D Coates
- Hematology Section, Children's Center for Cancer, Blood Diseases and Bone Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
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Woei-A-Jin FJSH, Zheng SZ, Kiliçsoy I, Hudig F, Luelmo SAC, Kroep JR, Lamb HJ, Osanto S. Lifetime Transfusion Burden and Transfusion-Related Iron Overload in Adult Survivors of Solid Malignancies. Oncologist 2019; 25:e341-e350. [PMID: 32043782 DOI: 10.1634/theoncologist.2019-0222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 07/31/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Limited data exist on transfusion burden and transfusion-related iron overload in adult survivors of solid malignancies. METHODS Hospital-specific cancer registry data of patients with solid tumor receiving systemic anticancer treatment between January 2008 and September 2009 at the Oncology Department of the Leiden University Medical Center (The Netherlands) were retrieved and cross-referenced with red blood cell (RBC) transfusion records. Individual lifetime transfusion burden was captured in April 2015. Multitransfused long-term survivors with serum ferritin >500 μg/L were subsequently screened for hepatic and cardiac iron overload using 1.5 Tesla magnetic resonance imaging. RESULTS The study population consisted of 775 adult patients with solid cancer (45.2% male; median age, 58 years; >75% chemotherapy-treated), 423 (54.6%) of whom were transfused with a median of 6.0 RBC units (range 1-67). Transfusion triggers were symptomatic anemia or hemoglobin <8.1-8.9 g/dL prior to each myelosuppressive chemotherapy cycle. We identified 123 (15.9%) patients across all tumor types with a lifetime transfusion burden of ≥10 RBC units. In the absence of a hemovigilance program, none of these multitransfused patients was screened for iron overload despite a median survival of 4.6 years. In 2015 at disclosure of transfusion burden, 26 multitransfused patients were alive. Six (23.1%) had hepatic iron overload: 3.9-11.2 mg Fe/g dry weight. No cardiac iron depositions were found. CONCLUSION Patients with solid malignancies are at risk for multitransfusion and iron overload even when adhering to restrictive RBC transfusion policies. With improved long-term cancer survivorship, increased awareness of iatrogenic side effects of supportive therapy and development of evidence-based guidelines are essential. IMPLICATIONS FOR PRACTICE In the presence of a restrictive transfusion policy, ∼30% of transfused adult patients with solid cancer are multitransfused and ∼50% become long-term survivors, underscoring the need for evidence-based guidelines for the detection and management of transfusion-related iron overload in this group of patients. In each institution, a hemovigilance program should be implemented that captures the lifetime cumulative transfusion burden in all patients with cancer, irrespective of tumor type. This instrument will allow timely assessment and treatment of iron overload in cancer survivors, thus preventing organ dysfunction and decreased quality of life.
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Affiliation(s)
- F J Sherida H Woei-A-Jin
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Laboratory of Clinical Chemistry and Hematology, Haga Hospital, The Hague, The Netherlands
| | - Shu Zhen Zheng
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Inci Kiliçsoy
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Francisca Hudig
- Department of Laboratory of Clinical Chemistry and Hematology, Haga Hospital, The Hague, The Netherlands
| | - Saskia A C Luelmo
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Susanne Osanto
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
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