Posttransfusion hemochromatosis and cardiorenal syndrome. Local register data

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Objective. Evaluation of the effect of posttransfusion hemochromatosis (HC) on renal and cardiac function.

Material and methods. The retrospective analysis included 24 patients with posttransfusion HC, of whom 20 were men (64.65±14.19 years) and 4 women (60.5±19.87 years), mean age 63.95±14.84 years. Almost half (46%) of the patients were diagnosed with myelodysplastic syndrome. Less commonly (17%) patients had acute myeloblastic leukemia. Chronic myeloproliferative disease was diagnosed in 9% of patients. All patients received blood transfusions. In all patients, clinical and basic biochemical parameters, incl. ferritin level, were monitored over time. Electrocardiography (ECG) and echocardiography (Echo-CG), abdominal an renal ultrasound examination were performed.

Results. Chronic kidney disease (CKD) was diagnosed in 41.7% of patients: stage C2 (n=2), stage C3a (n=5), stage C3b (n=1), stage C4 (n=1), stage C5 (n =1). The causes of CKD inclued hypertension, diabetes mellitus (n=5). Chronic heart failure (CHF) was diagnosed in 37.5% of patients from the sample: stage I (n=1), stage IIA (n=6), stage IIB (n=1) and stage III (n=1). The causes of CHF included hypertension, coronary artery disease. Patients were treated in accordance with current clinical guidelines. All patients were diagnosed with posttransfusion HC. Patients received deferasirox, the dose and duration of therapy were adjusted taking into account ferritin levels over time. A moderate positive correlation (r=0.581; p=0.003) between the transfusion load and ferritin level, as well as a moderate positive correlation (r=0.416; p=0.043) between the ferritin and creatinine levels were found. In the analyzed sample, 8 patients died in the hospital. The cause of death was progression of the underlying disease with the development of multiple organ failure syndrome.

Conclusion. In the presence of a high transfusion load, the blood ferritin level increases. The higher the ferritin level, the higher the creatinine level. There is a correlation between the presence of CHF and CKD.

Full Text

Restricted Access

About the authors

Mikhail D. Matveev

City Clinical Hospital № 38, Nizhny Novgorod

Email: araxes96@icloud.com
ORCID iD: 0000-0002-4597-1981

Doctor at the City Clinical Hospital № 38

Russian Federation, Nizhny Novgorod

Zinaida D. Mikhailova

City Clinical Hospital № 38, Nizhny Novgorod

Author for correspondence.
Email: zinaida.mihailowa@yandex.ru
ORCID iD: 0000-0002-0926-6038

Dr.Sci. (Med.), Associate Professor, Consultant, City Clinical Hospital № 38

Russian Federation, Nizhny Novgorod

References

  1. Перегрузка железом: диагностика и лечение. Национальные клинические рекомендации. 2018. 14 с. [Iron overload: diagnosis and treatment. National clinical guidelines. 2018. 14 p. (In Russ.)].
  2. Sandnes M., Ulvik R.J., Vorland M., Reikvam H. Hyperferritinemia – A Clinical Overview. J. Clin. Med. 2021;10(9):2008. doi: 10.3390/jcm10092008.
  3. List A.F. Iron overload in myelodysplastic syndromes: diagnosis and management. Cancer Control. 2010;17:2–8.
  4. Girelli D., Busti F., Brissot P., et al. Hemochromatosis classification: update and recommendations by the BIOIRON Society. Blood. 2022;139(20):3018–29. doi: 10.1182/blood.2021011338.
  5. Кляритская И.Л., Максимова Е.В. Клинические практические рекомендации по ведению пациентов с гемохроматозом. Крымский терапевтический журнал. 2012;2:41–6. УДК: 616-003.829.1-07-08. [Klaritskaya I.L., Maximova E.V. Clinical practical recommendations for the management of patients with hemochromatosis. Crimean Ther. J. 2012;2:41–6. UDC: 616-003.829.1-07-08 (In Russ.)].
  6. Ashankyty I., Al-hazimi A.M., Hussain Gadelkarim Ahmed. Genetic prediction of iron overload in chronic ranail failure. Med. Sci. 2020;24(104):2707–11.
  7. Girelli D., Busti F., Brissot P., et al. Hemochromatosis classification: update and recommendations by the BIOIRON Society. Blood. 2021 Oct 3: blood.2021011338.
  8. Daniłowicz-Szymanowicz L., Świątczak M., Sikorska K., et al. Pathogenesis, Diagnosis, and Clinical Implications of Hereditary Hemochromatosis – The Cardiological Point of View. Diagnostics (Basel). 2021;11(7):1279.
  9. Saad A.K., Aladio J.M., Yamasato F., et al. Analysis of the left atrial function using two-dimensional strain in patients with recent diagnosis of hereditary hemochromatosis. Eur. Heart J. Cardiovasc. Imaging. 2021;22(Suppl. 1).
  10. Анемия при злокачественных новообразованиях. Национальные клинические рекомендации. 2020 г. 37 с. [Anemia in malignant neoplasms. National clinical guidelines. 2020 37 p. (In Russ.)].
  11. Анемия при хронической болезни почек. Национальные клинические рекомендации. 2020. 36 с. [Anemia in chronic kidney disease. National clinical guidelines. 2020 36 p. (In Russ.)].
  12. Железодефицитная анемия. Национальные клинические рекомендации. 2021. 45 с. [Iron deficiency anemia. National clinical guidelines. 2021. 45 p. (In Russ.)].
  13. Острое повреждение почек. Национальные клинические рекомендации. 2022. 142 с. [Acute kidney injury. National clinical guidelines. 2022. 142 p. (In Russ.)].
  14. Хроническая болезнь почек. Национальные клинические рекомендации. 2021. 233 с. [Chronic kidney disease. National clinical guidelines. 2021. 233 p. (In Russ.)].
  15. Кардиология. Национальное руководство. Под ред. Е.В. Шляхто. 2-е изд., перераб. и доп. М., 2023. 816 с. [Cardiology. National leadership. Edited by E.V. Shlyakhto. 2nd ed., reprint. and additional M., 2023. 816 p. (In Russ.)].
  16. Zhang Y., Jiang Y., Yang W., et al. Chronic Secondary Cardiorenal Syndrome: The Sixth Innovative Subtype. Front. Cardiovasc. Med. 2021;8:1–4.
  17. Ronco C., McCullough P., Anker S., et al. Cardio-renal syndromes: report from the consensus conference of the Acute Dialysis Quality Initiative. Eur. Heart J. 2010;31:703–11.
  18. Маршина Е.А., Куликова О.В., Мясников Р.П. и др. Некомпактный миокард у пациентов с гемохроматозом: феномен или кардиопатия? Роль магнитно-резонансной томографии и молекулярно-генетических методов исследований в диагностике. Рос. кардиологический журнал. 2020;25(4):54–64. [Marshina E.A., Kulikova O.V., Myasnikov R.P., et al. Non-compact myocardium in patients with hemochromatosis: a phenomenon or cardiopathy? The role of magnetic resonance imaging and molecular genetic research methods in diagnostics. Rus. Cardiol. J. 2020;25(4):54–64 (In Russ.)].
  19. Феоктистова Е.В., Сметанина Н.С., Делягин В.М., Дубровин М.М. Состояние сердца при синдроме перегрузке железом. Практич. медицина. 2013;6(75):59–60. ID: 20868957. [Feoktistova E.V., Smetanina N.S., Delyagin V.M., Dubrovin M.M. Heart condition in iron overload syndrome. Praktich. Med. 2013;6(75):59–60 (In Russ.)].
  20. Pepe A., Positano V., Santarelli M.F., et al. Multislice multiecho T2* cardiovascular magnetic resonance for detection of the heterogeneous distribution of myocardial iron overload. J. Magn. Reson. Imaging. 2006;23(5):662–68. doi: 10.1002/jmri.20566.
  21. Gordan R., Fefelova N., Gwathmey J.K., Xie L.H. Iron Overload, Oxidative Stress and Calcium Mishandling in Cardiomyocytes: Role of the Mitochondrial Permeability Transition Pore. Antioxidants (Basel). 2020;9(8):758. doi: 10.3390/antiox9080758.
  22. Yukna C.G. A Tale of Two Beers. August 2020. doi: 10.13140/RG.2.2.19652.24962.
  23. Волошина Н.Б., Осипенко М.Ф., Литвинова Н.В., Волошин А.Н. Гемохроматоз – современное состояние проблемы. Тер. архив. 2018;3:107–12. [Voloshina N.B., Osipenko M.F., Litvinova N.V., Voloshin A.N. Hemochromatosis – the current state of the problem. Ther. Arch. 2018;3:107–12 (In Russ.)].
  24. Kowdley K.V., Brown K.E., Ahn J., Sundaram V. ACG Clinical Guideline: Hereditary Hemochromatosis. Am. J. Gastroenterol. 2019;114(8):1202–18.
  25. Mohammad G., Matakidou A., Robbins P.A., Lakhal-Littleton S. The renal hepcidin/ferroportin axis controls iron reabsorption and determines renal and hepatic susceptibility to iron overload. bioRxiv. 2020;7:1–24.
  26. Kang H., Han M., Xue J., et al. Renal clearable nanochelators for iron overload therapy. Nat. Commun. 2019;10:5134.
  27. Vidal 2022. Справочник Видаль. Лекарственные препараты в России. М., 2022. 1120 с. [Vidal 2022. The Vidal Handbook. Medicines in Russia. M., 2022. 1120 p.].
  28. Revilla-Martí P., Pelegrín-Díaz J., Rodrigo-Trallero G., et al. «Ventricular tachycardia in a patient with cardiac haemochromatosis and normal left-ventricular ejection fraction». Semin. Cardiovasc. Med. 2019;25(1):1–3.
  29. Shi zukuda Y., Rosing D.R. Iron overload and arrhythmias: Influence of confounding factors. J. Arrhythm. 2019;35(4):575–83.
  30. Thévenod F., Lee W.-K., Garrick M.D. Iron and Cadmium Entry Into Renal Mitochondria: Physiological and Toxicological Implications. Front. Cell Dev. Biol. 02 September 2020. https://doi.org/10.3389/fcell.2020.00848

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Frequency and structure of diseases that led to secondary GC due to blood transfusions (numbers in chart are number of patients)

Download (201KB)
Indexing metadata
3. Fig. 2. Transfusion load (the numbers in the chart are the number of patients receiving blood transfusions at different frequencies)

Download (90KB)
Indexing metadata

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies