Iron Profile in Multiple Myeloma and Chronic Kidney Disease BC01-BC05
Dr. R Kowsalya,
Room No 9, Institute of Nephrourology, Victoria Hospital Campus, Bangalore-560002, Karnataka, India.
Introduction: In normal individuals serum ferritin levels would indicate the body iron stores. Ferritin levels are known to be increased despite the low body iron stores in conditions like chronic inflammation and malignancies. However, the increased levels of ferritin and its correlation with the other iron profile parameters need to be validated in Chronic Kidney Disease (CKD) and Multiple Myeloma (MM).
Aim: To compare the abnormalities of iron profile markers in CKD and MM with age and sex matched controls and to find out whether Serum Ferritin (SF) levels correlate with body iron stores in these clinical states.
Materials and Methods: This was a hospital-based retrospective study done in tertiary care Nephrourology Centre, Bangalore, Karnataka, India from April 2017 to April 2018. Patients attending routine nephrology OPD were included in the study. There were three study groups, group I (n=50) included non-dialysed CKD patients, group II (n=50) included newly diagnosed cases of MM using International Myeloma Working Group (IMWG) criteria and group III (n=50) consisted of controls included age and sex matched normal subjects who had been referred to the laboratory centre for routine check-up. Iron profile which includes Serum Iron (SI), Total Iron Binding Capacity (TIBC), Transferrin Saturation (TS), and SF, was done in all the subjects enrolled in the study. Data analysis was done by Statistical Package for Social Science (SPSS) version 17. The significance level, or p-value, was calculated using the unpaired t-test.
Results: In the CKD group (n=50), only seven patients had normal iron profile. Forty-three patients had deranged iron profile. Among these 43 cases, the mean SI was 34±10 ug/dL, mean TIBC was 206±39 ug/dL, mean TS was 17±9 ug/dL. SF levels were >100 ng/dL in 20 CKD patients and <100 ng/dL in 30 CKD patients. In MM patients (n=50), five had normal iron profile. Forty five patients had abnormal iron profile with mean SI levels 29±9 ug/dL, low TIBC 163±10 ug/dL, low TS 13±4 ug/dL, and SF was 793±20 ng/dL. On comparison of CKD and MM patients with controls; the mean values of SI, TIBC and TS were significantly lower than controls (p<0.05). Also, the mean SF values of CKD and MM group patients were significantly higher than the controls (p<0.05). Also, the values of all these parameters (SI, TIBC, TS, SF) were much more deranged in MM group compared with the CKD group and this was statistically significant (p-value <0.05).
Conclusion: High ferritin values in these patient groups should not be mistaken for iron overload; rather a prompt correction of iron deficiency must be sought based on total iron profile assessment.