Iron overload in children with leukaemia: Experience of The Only Department of Pediatric Hematology Oncology in Kuwait

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maha Bourisly M. Bourhama M.A. Obaid N. Basili


Children with leukaemia are prone to severe anaemia dueto the disease itself and the medication; they usuallyreceive multiple blood transfusions throughouttheir treatment when they develop severe anaemia as a side effect of the disease and chemotherapy received. This is an observational cross-sectional study of 50 children who werediagnosed with leukaemia and treated at NBK paediatrichaematology and oncology department, Sabah hospital.The aim of this study was to see whether intensechemotherapy affects the amount of blood transfusionsreceived, hence leading to iron overload. Serum ferritinlevel was tested in each patient who were atdifferent stages of treatment (after parents' consent). Forty-four childrenwere receiving their chemotherapy at the time ofsampling and were at different stages of theirtreatment, whereas six children have already completedtheir chemotherapy in accordance to theirchemotherapy treatment protocol. Serum ferritin level was observed to be increasing as the patient progress in treatment. The risk of the disease and multiple blood transfusions might lead to increased level of serumferritin level (multiple correlation coefficient 0.664, coefficient of determination =38%) however they were not only the only determinant of the iron overload. Most children have received multiple blood transfusions by the end of chemotherapy treatment protocol(p=0.001).  Iron overload has an accumulative effect that can still be clearly seen towards the end of chemotherapy protocol.

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BOURISLY, maha et al. Iron overload in children with leukaemia: Experience of The Only Department of Pediatric Hematology Oncology in Kuwait. Medical Research Archives, [S.l.], v. 5, n. 3, mar. 2017. ISSN 2375-1924. Available at: <>. Date accessed: 29 mar. 2023.
ALL, iron overload, blood transfusion
Research Articles


1. Armand P, Kim HT, Rhodes J, Sainvilmm, Cutter C. Iron overload in patients with acute leukaemia or MDS undergoing myeloablative stem cell transplantation. Biol Blood Marrow Transplant. 2011 June; 17(6): 852-60.
2. Barton JC, Bertoli LF. Transfusion iron overload in adults with acute leukaemia: manifestations and therapy. Am J Med Sci. 2000 feb 319(2): 73-8.
3. Bebeshko VG, Bruslova EM, Tsvietkova NM, et al. Effect of RBC concentrate transfusions on serum ferritin content in children with acute leukaemia. Probl Radiac Med Radiobiol. 2013;(18):173-9.
4. Eng J, Fish JD. Insidious iron burden in pediatric patients with acute lymphoblastic leukemia. Pediatr Blood Cancer. 2011 Mar;56(3):368-71. doi: 10.1002/pbc.22851.
5. Fukushima T, Kawabata H, Nakamura T, Iwao H, Nakajima A, Miki M, Sakai T, Sawaki T, Fujita Y, Tanaka M, Masaki Y, Hirose Y, Umehara H.Iron chelation therapy with deferasirox induced complete remission in a patient with chemotherapy-resistant acute monocytic leukemia. Anticancer Res. 2011 May;31(5):1741-4.
6. Halonen P, Mattila J, Suominen P, Ruuska T,et al. Iron overload in children who are treated for acute lymphoblastic leukemia estimated by liver siderosis and serum iron parameters. Pediatrics. 2003 Jan;111(1):91-6.
7. Kim KH, Kim JW, et al. Cost analysis of iron-related complications in a single institute. Korean J Intern Med. 2009 Mar;24(1):33-6. doi: 10.3904/kjim.2009.24.1.33.
8. Lipshultz SE, Lipsitz SR, Sallan SE, Dalton VM, Mone SM, Gelber RD, Colan SD. Chronic progressive cardiac dysfunction years after doxorubicin therapy for childhood acute lymphoblastic leukemia. J Clin Oncol. 2005 Apr 20;23(12):2629-36.
9. Lipshultz SE, Lipsitz SR, Kutok JL, Miller TL, et al. Impact of hemochromatosis gene mutations on cardiac status in doxorubicin-treated survivors of childhood high-risk leukemia. Cancer. 2013 Oct 1;119(19):3555-62. doi: 10.1002/cncr.28256. Epub 2013 Jul 16.
10. Matsuki E, Matsumoto K, Nakaya A, et al.Marked improvement of anemia during treatment with deferasirox in patients with primary myelofibrosis and acute myeloid leukemia with myelodysplasia-related changes. Rinsho Ketsueki. 2012 Jan;53(1):78-82.
11. Nottage K, Gurney JG, Smeltzer M, Castellanos M, et al. Trends in transfusion burden among long-term survivors of childhood hematological malignancies. 2013 Aug;54(8):1719-23. doi: 10.3109/10428194.2012.750724. Epub 2012 Dec 22.
12. Olcay L, Hazirolan T, Yildirmak Y, Erdemli E,et al. Biochemical, radiologic, ultrastructural, and genetic evaluation of iron overload in acute leukemia and iron-chelation therapy. J Pediatr Hematol Oncol. 2014 May;36(4):281-92. doi: 10.1097/MPH.0b013e3182a11698.
13. Rascon J., Rageliene L., Stankeviciene S. , Palionis D. , Edvardas A. Tamosiunas, et al.. An assessment of iron overload in children treated for cancer and nonmalignant hematologic disorders. European Journal of Pediatrics, September 2014, Volume 173, Issue 9, pp 1137-1146 First online: 23 March 2014.
14. Ruccione KS, Wood JC, Sposto R, Malvar J, Chen C, Freyer DR. Characterization of transfusion-derived iron deposition in childhood cancer survivors. Cancer Epidemiol Biomarkers Prev. 2014 Sep;23(9):1913-9. doi: 10.1158/1055-9965.EPI-14-0292. Epub 2014 Jun 24.
15. Reitman AJ, Coates TD, Freyer DR. Early Cardiac Iron Overload in a Child on Treatment of Acute Lymphoblastic Leukemia. Pediatrics. 2015 Sep;136(3):e697-700. doi: 10.1542/peds.2014-3770. Epub 2015 Aug 17.
16. Schrijvers D. Management of anemia in cancer patients: transfusions. Oncologist. 2011;16 Suppl 3:12-8.
17. Sirvent A, Auquier P, Oudin C, Bertrand Y, Bohrer S, Chastagner P, et al..Prevalence and risk factors of iron overload after hematopoietic stem cell transplantation for childhood acute leukemia: a LEA study. Bone Marrow Transplant. 2017 Jan;52(1):80-87. doi: 10.1038/bmt.2016.205. Epub 2016 Sep 5.
18. Vag T, Kentouche K, Krumbein l, Reichenbach JR. Non invasive measurement of liver iron concentration at MRI in children with acute leukaemia; initial results. Pediatr Radiol. 2011 Aug;41(8):980-4.
19. Unal S, Cetin M, Hazirolan T, et al.Number of erythrocyte transfusions is more predictive than serum ferritin in estimation of cardiac iron loading in pediatric patients with acute lymphoblastic leukemia. Leuk Res. 2014 Aug;38(8):882-5. doi: 10.1016/j.leukres.2014.05.002. Epub 2014 May 14.
20. Webb IJ, Anderson KC. Transfusion support in acute leukemias. Semin Oncol. 1997 Feb;24(1):141-6.