Daar Shahina, Ahmed Saeed, Berdoukas Vasili
Department of Haematology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman.
Sultan Qaboos Univ Med J. 2010 Dec;10(3):401-4. Epub 2010 Nov 14.
Iron loading in patients with transfusion dependent thalassaemia is considered to occur primarily in the liver and, once the liver becomes saturated, other organs begin loading. We report here a splenectomised male patient who was treated for hepatitis C virus infection. Prior to starting antiviral therapy, his serum ferritin was maintained below 500 ng/ml with deferiprone monotherapy; cardiac T2* by magnetic resonance imaging was 48.8ms and hepatic T2* was 19.5ms. After twelve months of antiviral treatment during which time he was very poorly compliant with his deferoxamine chelation therapy, his ferritin had risen to 3820 ng/ml and cardiac and hepatic T2* findings were 12.7 ms and 14.5 ms respectively, indicating increased iron loading in both organs, but particularly in the heart. Fifteen months after recommencing combination chelation, his ferritin was 95 ng/ml and cardiac and hepatic T2* were 27.5 and 28.4ms respectively, indicating complete clearance of iron load in both organs. This case demonstrates that iron overload can develop rapidly and in some cases there is relatively rapid iron loading in the heart as compared to the liver.
依赖输血的地中海贫血患者的铁负荷被认为主要发生在肝脏，一旦肝脏饱和，其他器官便开始蓄积铁。我们在此报告一名接受过脾切除术的男性患者，他曾接受丙型肝炎病毒感染的治疗。在开始抗病毒治疗之前，他通过去铁酮单药治疗将血清铁蛋白维持在500 ng/ml以下；磁共振成像显示心脏T2为48.8ms，肝脏T2为19.5ms。在抗病毒治疗的十二个月期间，他对去铁胺螯合疗法的依从性很差，其铁蛋白升至3820 ng/ml，心脏和肝脏的T2结果分别为12.7 ms和14.5 ms，表明两个器官的铁负荷均增加，但心脏尤为明显。重新开始联合螯合治疗十五个月后，他的铁蛋白为95 ng/ml，心脏和肝脏的T2分别为27.5和28.4ms，表明两个器官的铁负荷已完全清除。该病例表明铁过载可能迅速发展，在某些情况下，与肝脏相比，心脏的铁蓄积相对较快。
