Image: A histopathology of lung tissue from a patient with hemosiderosis: in the alveolar spaces and in the septa are hemosiderin-laden macrophages (Photo courtesy of Getty Images).
Hemosiderosis is a type of secondary iron overload resulting from multiple blood transfusions and the leading cause of death in transfusion-dependent patients with thalassemia.
Severe hemosiderosis is characterized by dysfunction of iron-overloaded organs resulting in hepatic fibrosis and cirrhosis, cardiac failure and arrhythmias, endocrine pancreatic dysfunction, hypothyroidism, and hypogonadism.
Scientists at the University Medical Centre Utrecht (Netherlands) retrospectively assessed hemosiderosis screening and prevalence in adult patients that received over 20 red blood cell (RBC) units in the University Medical Centre from 2010 till 2015. Hemosiderosis was defined as ferritin equal to or greater than 1,000 μg/L. Adequate screening for chronically transfused patients was defined as any ferritin determined up to three months before or any moment after the last transfusion, while for patients that received all transfusions within three months (bulk transfusion), ferritin had to be determined after at least twenty transfusions.
The team identified 471 patients who received more than 20 RBC units. The median age was 62 years, and 65% of the recipient patients were male. Of 471 patients, only 38.6% was adequately screened and hemosiderosis prevalence was 46.7%. Hemosiderosis prevalence was 47% in the chronic transfusion group and 12% in the bulk transfusion group. In patients transfused because of hematological malignancy or cardiothoracic surgery, respectively, 74% and 31% were adequately screened and hemosiderosis prevalence was 53% and 13%, respectively.
The authors concluded that screening for hemosiderosis in adult multiple transfused patients in the hospital was suboptimal, while hemosiderosis prevalence is high. Patients who are chronically transfused or transfused at the hematology ward are especially at risk to develop hemosiderosis. More importantly, they found that hemosiderosis is not an exclusive complication of multiple transfusion in the hematology ward but can affect any patient receiving multiple transfusions. They recommend screening for hemosiderosis in all patients receiving multiple transfusions. The study was published in the May 2017 issue of the European Journal of Hematology.
University Medical Centre Utrecht