Longitudinal Ferritin Trends as a Marker of Transfusion Burden in Beta-Thalassemia Major
DOI:
https://doi.org/10.5281/zenodo.22818719Keywords:
ferritin, beta-thalassemia major, transfusion burden, iron overload, chelation therapyAbstract
Background: Serum ferritin has been used to track transfusional iron burden in beta-thalassemia major since cohort studies linked sustained values above roughly 2500 ng/mL to markedly worse cardiac-disease-free survival [1,2].
Objective: This review synthesizes the published evidence on longitudinal ferritin trend as a marker of transfusion burden, its correlation with directly measured liver and cardiac iron, and its role alongside MRI-based monitoring and chelation response assessment.
Methods: We synthesized peer-reviewed cohort studies, randomized chelation trials, and MRI validation studies addressing ferritin, transfusion volume, liver iron concentration, and cardiac T2* in transfusion-dependent thalassemia major.
Findings: Ferritin correlates with liver iron concentration at coefficients around 0.6-0.8 [4], transfusion regimen intensity directly alters iron loading [3], and cardiac T2* below 6 ms carries a roughly 47% one-year heart failure incidence that ferritin trend alone does not resolve with comparable precision [13]; chelation trials show dose-dependent ferritin and liver iron reductions with deferasirox and combination regimens [17,19].
Conclusions: Longitudinal ferritin trend remains a useful, low-cost surveillance tool for transfusion burden when interpreted as a trajectory rather than a single value and combined periodically with organ-specific MRI iron quantification, particularly for the myocardium, where ferritin's predictive value is weakest [16,5].
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Copyright (c) 2019 Iveta Trnka, et al.
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