Prevalence of iron overload among patients with transfusion dependent anaemia attending Muhimbili National Hospital

Abstract

Background:Blood transfusion provides a major rapid and effective treatment for transfusion dependent anaemia patients including those with thalassemia, sickle cell anaemia, myelodysplastic syndrome, aplastic anaemia and haemolytic anaemia. Unfortunately transfusional iron overload among transfusion dependent anaemia patients has been shown to be a potentially serious problem that is often overlooked because the symptoms are nonspecific and often develop gradually. A number of diagnostic tests are available, but their interpretation can be challenging. Once transfusional iron overload is diagnosed, the options for treatment are relatively straightforward in the majority of individuals. However, untreated individuals can develop life-threatening morbidity and mortality related to organ toxicity. Thus, it is important to identify iron overload before organ damage occurs. Objectives:The study was performed to determine the prevalence of transfusional iron overload, to describe the clinical diagnosis,clinical presentation and iron status of individuals with transfusion dependent anaemia at MNH. Methodology: This was a descriptive, cross sectional hospital based study involving patients from 2 years and abovewith transfusion dependent anemia who have received ≥10transfusions or ≥100mls/kg of red blood cells in their life time, attending inpatient and outpatient hematology services at Muhimbili National Hospital. A structured questionnaire wasused to obtain information on socio-demographic particulars, type of illnessand number of blood transfusions one has received in certain period of time. Blood samples were drawn for full blood count, serum ferritin, serum iron,serum transferrin and C-reactive protein.The collected data were analyzed by using SPSS version 20.0. Results: Majority of patients were aged between 2 and 17 years 59 (52.7%), followed by 18- 35 years 28 (25%). In a total of 112 study participants 60(53.6%) were males. Of these 112 study participants, majority were observed to have aplastic anaemia37(33%), followed by acute leukemia 27 (24.1%).Most of the patients were observed to have had received blood transfusion for more than 12 months.The clinical signs and symptoms that were observed in transfusion dependent anaemia patients were tachycardia, bradycardia, skin hyperpigmentation and hepatomegaly.Serum ferritin, iron, and transferrin saturation were observed to be markedly elevated and transferrin was low. Of the 112 patients, 74.1% had ferritin levels > 1000ng/ml and 71.4% had TSAT > 45%. Conclusion:The prevalence of iron overload among transfusion dependent anaemia patients at Muhimbili National Hospital was 72.5%. Serum ferritin and transferrin saturation were observed to be significantly elevated in all clinical diagnoses observed in this study. Recommendation: Having confirmed that iron overload is common among transfusion dependent anaemia patients, there is a need of screening for iron overload in a patient with a history of recurrent blood transfusion of ≥ 10 units or ≥ 100mls/kg in lifetime. Ferritin level of > 1000ng/ml and TSAT of > 45% in a patient with the history of receiving blood transfusion of ≥ 10 units or ≥ 100mls/kg in life time, chelation therapy should be initiated since it is effective at reducing iron burden and preventing organ damage. Serum ferritin and transferrin saturation are the easily available tests that can be used to diagnose transfusional iron overload in our setup.