Pre-transplantation serum ferritin level in allogenic stem cell transplant patients in
Hospital Ampang
1
Subashini C. THAMBIAH MBBS, MPath, 1Elizabeth GEORGE MBBS, FRCPA, FRCPE, MD,
1
INTAN NURESLYNA Samsudin, MBBchBAO, MPath, 2Lee Hoong HONG, 2Ling Ling
CHUO, 2NABILAH Ramli, 3Muhd Zanapiah ZAKARIA MBChB, MMed
¹Department of Pathology, Faculty of Medicine and Health Sciences, University Putra Malaysia
²Faculty of Medicine and Health Sciences, University Putra Malaysia
³Department of Haematology, Hospital Ampang
Introduction: The principle cause of iron overload in patients with haematological malignancies
is recurrent red cell transfusions for anaemia. Serum ferritin reflects iron burden in the body in
the absence of inflammation or liver disease. Materials and Methods: A cross-sectional study
using retrospective data between 2008-2011 of 106 post-transplant patients (HLA-matched
sibling) with haematological malignancies was carried out at Hospital Ampang to investigate the
relationship between pre-transplant serum ferritin level with post-transplant outcome (alive or
dead) and survival time. Patients were divided into two groups according to iron status: serum
ferritin ≥ 1000 g/L (iron overload) and < 1000 g/L. Results: The median age for patients was
30.5 (18-58) years old. Prevalence of pre-transplantation iron overload in these patients was
87.5%. Median pre-transplantation serum ferritin level was 2423 (408.2-7664) µg/L. There was
no significant association between iron status and sociodemographic factors, type of
haematological malignancies and post-transplant complications. Although insignificant, patients
with iron overload had a shorter survival time (36 months) compared to non-iron overload
patients (40 months). There was also no significant association between iron status and posttransplant outcome. Discussion: Serum ferritin is an acute phase reactant and levels increase in
the presence of tissue necrosis and inflammation. Both these events are occurrences in
haematological malignancies. Although serum ferritin is a non-invasive, relatively cost effective,
widely available and practical indicator of iron status, it is not specific to iron overload.
Therefore, true association between serum ferritin and iron burden is problematic in patients with
haematological malignancies.
Key words: iron overload, pre-transplantation serum ferritin, haematological malignancy, posttransplant outcome, survival time