452 - Identifying Neonatal Iron Overload in Transfusion-Related Hyperferritinemic Neonates

Poster Number: 452
Publication Number: 452.1865

Background: Iron supplementation promotes improved neurocognitive outcomes in VLBW infants. Those receiving RBC transfusions are at risk of comorbidities associated with iron deficiency and iron overload. Ferritin is a biomarker for iron stores and current recommendations are to withhold iron supplementation in VLBW infants with transfusion-related hyperferritinemia. Restrictive iron supplementation however, may affect long-term outcomes. Understanding the implications of transfusion-related hyperferritinemia is vital in overall health outcomes of this high-risk population.

Objective: Identify the correlation between RBC transfusion-related hyperferritinemia and iron overload in VLBW infants.

Design/Methods: Retrospective cohort study, identifying iron overload in transfusion-related hyperferritinemic infants. Iron studies were obtained 2 weeks after the infant’s second RBC transfusion. Hyperferritinemia is defined as ferritin >300ng/mL and iron overload as hyperferritinemia with transferrin saturation percentage (TS%)>60. Iron studies were repeated every 2 weeks until resolution of hyperferritinemia. Point biserial correlation (rpb) is used to identify the relationship of ferritin levels and iron overload.

Results: In 16 VLBW infants (mean GA 25wks, IQR 24-27;mean BW 755g,IQR 617-1110) with transfusion-related hyperferritinemia (ferritin mean 497ng/mL, TS% mean 44, IQR 27.5 - 80.0), 2(12.5%) had iron overload. The association between hyperferritinemia and iron overload was not significant at 0.35(p=0.09). The relationship between ferritin and TS% was found to have a rpb factor of 0.46, while its relationship with transfusion volume (mean volume 11mL,IQR 9-12.5) was found to be -0.47. CRP, (median 0.3mg/dL,IQR 0.2-0.5mg/dL) had a negligible correlation of -0.24.

Conclusion(s): Based on our preliminary data, there is low correlation between transfusion-related hyperferritinemia and iron overload given absence of linear relationship between ferritin values and iron overload. we observed that ferritin wasn't positively correlated with CRP, which led us to conclude that the hyperferritinemic state was not due to a concurrent inflammatory process. Our data suggests that isolated ferritin values may not be reliable in depicting iron stores in VLBW with history of RBC transfusions. Given the positive correlation between ferritin and TS%, a combined approach utilizing ferritin in addition to other iron biomarkers may be more reliable in identifying iron overload. Recognizing reliable iron investigational studies may better guide enteral iron supplementation in VLBW infants with transfusion-related hyperferritinemia.