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Blood, 5 November 2009, Vol. 114, No. 19, pp. 4021-4026. Prepublished online as a Blood First Edition Paper on September 2, 2009; DOI 10.1182/blood-2009-06-225615. This Article Full Text Full Text (PDF) All Versions of this Article: blood-2009-06-225615v1 114/19/4021    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Google Scholar Articles by Noetzli, L. J. Articles by Wood, J. C. PubMed PubMed Citation Articles by Noetzli, L. J. Articles by Wood, J. C. Related Collections Free Research Articles Red Cells, Iron, and Erythropoiesis Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS Pancreatic iron loading predicts cardiac iron loading in thalassemia major Leila J. Noetzli1, Jhansi Papudesi1, Thomas D. Coates2, and John C. Wood1,3 Divisions of 1 Cardiology and 2 Hematology-Oncology, Department of Pediatrics, and 3 Department of Radiology, Childrens Hospital Los Angeles, CA Diabetes mellitus and cardiomyopathy are common in chronically transfused thalassemia major patients, occurring in the second and third decades of life. We postulated that pancreatic iron deposition would precede cardiac iron loading, representing an environment favorable for extrahepatic iron deposition. To test this hypothesis, we examined pancreatic and cardiac iron in 131 thalassemia major patients over a 4-year period. Cardiac iron (R2* > 50 Hz) was detected in 37.7% of patients and pancreatic iron (R2* > 28 Hz) in 80.4% of patients. Pancreatic and cardiac R2* were correlated (r2 = 0.52), with significant pancreatic iron occurring nearly a decade earlier than cardiac iron. A pancreatic R2* less than 100 Hz was a powerful negative predictor of cardiac iron, and pancreatic R2* more than 100 Hz had a positive predictive value of more than 60%. In serial analysis, changes in cardiac iron were correlated with changes in pancreatic iron (r2 = 0.33, P < .001), but not liver iron (r2 = 0.025, P = .25). As a result, pancreatic R2* measurements offer important early recognition of physiologic conditions suitable for future cardiac iron deposition and complementary information to liver and cardiac iron during chelation therapy. Staging abdominal and cardiac magnetic resonance imaging examinations could significantly reduce costs, magnet time, and need for sedation in young patients. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

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