Deferiprone challenge test for monitoring iron overload in hepatitis positive thalassemic major patients

Viral hepatitis is common among beta-thalassemia major (BTM) children in Pakistan. Transfusional iron overload in BTM is usually monitored by serum ferritin. But its levels are falsely raised in viral hepatitis and do not reflect the true iron body burden in thalassemic patients. The objective of the study was to develop a test for monitoring iron overload in 'Hepatitis B&C' positive BTM patients by urinary iron excretion (UIE) after oral deferiprone chelation as compared to serum ferritin. We recruited 130 BTM patients from the registry of Thalassaemia centre at Rawalpindi, Pakistan. The patients were grouped into Hepatitis positive and Hepatitis negative based on ELISAtest. Serum ferritin levels were analyzed by kit on Access II. Each patient was given 75mg/kg of deferiprone at morning. Baseline UIE before deferiprone, and 4, 8 12 hours (hrs) UIE after deferiprone were analyzed on Selectra E. One hundred and thirty BTM patients aged 3 to 23 years comprising of Hepatitis positive (n=69) and Hepatitis negative (n=61) participated in the study. Hepatitis positive thalassemic patients had significantly high serum ferritin median (IQ) 4349 (2782-5927) mug/Lthan 3338 (2189-5506) mug/Lin the Hepatitis negative (p=0.001). We did not find any significant change in UIE at 4, 8, and 12 hours between two groups after Deferiprone intake (p=NS). We observed significant positive correlation between serum ferritin and 4 hours UIE in Hepatitis negative patients (r=0.57; p=0.01) but not in the Hepatitis positive patients (r=0.16; p=NS). Deferiprone challenge with measurement of 4 hours UIE is cost effective and non-invasive test rather than serum ferritin for monitoring iron overload in Hepatitis' positive BTM patients.