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.