Correlation between serum ferritin and transfusion and other variables in children with sickle cell disease
Abstract
Sickle cell anaemia is a fairly common disease in this country. One previous study
showed a national prevalence of approximately 3-4%. It influences all aspects of life of
affected individuals. The disease is characterised by a myriad of complications with
multiple organ involvement The prognosis of patients in this environment is generally
poor. Management of sickle cell disease continues to be primarily palliative in nature,
and includes supportive, symptomatic and preventive approaches to therapy. The main
stimulus for study was the fact that sickle haemoglobin results in a chronic haemolytic
haemoglobinopathy and that these patients undergo frequent transfusions, making them
at risk of iron overload. Most of similar studies in other parts of the world have reported
increased iron load in their populations. It was important to document the serum ferritin
profile in patients in this setting for the purposes of improving management, providing
knowledge and stimulate further local based research in related aspects of sickle cell
disease.
The broad objective of the study was to establish the serum ferritin levels in children
with sickle cell disease. Red blood cell indices were determined and peripheral blood
film examined. The serum ferritin levels were correlated to volume and number of
transfusions received, number of crises experienced in the preceding six months, age
and red cell indices.
This was a descriptive cross-sectional study. The study area was at the Kenyatta
National Hospital, Paediatric Haematology clinic. The study subjects were those
patients confirmed to have sickle cell disease and attending paediatric haematology
clinic at Kenyatta National Hospital. Fifty (50) subjects were studied. Serum ferritin
assays were done using ELISA (miniVIDAS) technique. Blood counts were done
using the haematology cell counter (CELL-DYN 1300) and the peripheral blood films
stained using May Grunwald Giemsa method. Quality control measures were
undertaken in all tests performed by observing the reagent manufacturer's guidelines
and standard specimen handling/laboratory operating procedures, to ensure validity of
results.
Majority of the patients (73.5%) had raised serum ferritin and mean level was 391.8
ng/ml. All had anaemia with mean Hb of7.5 g/dl. Serum ferritin levels did not
correlate with age at diagnosis, red blood cell indices, crisis experience and number of
transfusions received. There was however significant correlation with transfusion
volume per kilogram body weight. There was an inverse relationship between ferritin
and haemoglobin levels.
Citation
Masters of Medicine (Human Pathology)Publisher
University of Nairobi School of Medicine