Serum Ferritin Levels In Patients with Sickle Cell Anaemia atthe Kenyatta National Hospital

Background: The iron levels in Sickle Cell Anaemia (SCA) is thought to be increased because of the repeated red cell transfusion, haemolysis with subsequent recycling and accumulation of iron. Red cell transfusion is used frequently to prevent and treat the complications of sickle cell disease. Studies have shown that the changes in iron status that results from such therapy is associated with significant morbidity and mortality. Thisstudy examined the serum ferritin as a marker of iron levels in patients with sickle cell disease who receive chronic red blood cell transfusion. Objective: The aim of this study was to assess the status of serum iron levels by measurement of serum ferritin in patients with sickle cell Anaemia managed at Kenyatta National Hospital. Setting: The study was carried out at the Kenyatta National Hospital Haematology clinic. Design: Cross-sectional descriptive study Materials and methods: This study enrolled 80 patients with sickle cell anaemia. History and physical examination was done and recorded on study proforma. Samples of blood were then drawn for serum ferritin, full blood count including peripheral blood film. Serum ferritin was assessed using enzyme immunoassay sandwich method with a final fluorescent detection (ELFA) kits. Blood counts were done using the haematology cell counter (CELL-DYN 1300) whiles the peripheral blood films were stained using May Grunewald Giemsa method. Quality control measures were observed in all tests performed by adhering to reagent manufacturers’ guidelines and standard specimen handling/laboratory operating procedures, to ensure validity of results. Results: Eighty clinically stable patients with SCA were studied. Thirty-three were males (41.3%) while Forty-seven were females (58.7%). The mean age in the study population was 19.7±5.5 years with the youngest being 13years and the oldest 37years. Serum ferritin mean 939.25±668ng/ml, was found to be significantly elevated in 56 (70.5%) of our study subjects while 24 had normal SF levels and none of them had low SF. Twenty-five (31.3%) who had very high SF, above 1000ng/ml, had also been transfused a mean of 15±8.2 units of blood. There was a significant association between SF and the number of units of blood transfused, p=<0. 001.There was no demonstrable significant association between SF and age, sex or red cell parameters. Conclusion: This study revealed high serum ferritin in majority 70.5% of our patients with SCA. None of our patients had low SF. Very high serum ferritin, more than 1000ng/ml was observed in patients who received ≥15 units of blood over a period of five years. There was a significant association between serum ferritin levels and number of blood transfusions. Annual serum ferritin measurements are recommended to determine the iron status to institute prompt therapeutic measure of iron chelation.