# The Diagnostic Performance of Serum Glycosylated Ferritin in Patients Undergoing Regular Blood Transfusion: An Indicator of Iron Overload to Initiate Iron Chelation Therapy

## TL;DR

This study explores glycosylated ferritin as a more specific indicator of iron overload in patients receiving regular blood transfusions, suggesting it could help decide when to start iron chelation therapy.

## Contribution

The study introduces glycosylated ferritin as a novel potential biomarker for detecting iron overload in transfusion-dependent patients.

## Key findings

- Glycosylated ferritin levels were significantly higher in patients with transferrin saturation ≥50%, indicating iron overload.
- Glycosylated ferritin showed strong correlations with ferritin and transferrin saturation, and a cutoff value of >587.55 ng/mL was identified for iron overload.
- Glycosylated ferritin correlated better with blood transfusion units than serum ferritin.

## Abstract

Background and objective

Serum ferritin concentration and transferrin saturation are commonly employed to estimate body iron but are non-specific to iron overload. Glycosylated ferritin may be primarily elevated in cases of iron overload in patients undergoing regular blood transfusions. In this study, we aimed to estimate glycosylated ferritin and determine its cutoff values for iron overload in patients receiving blood transfusions regularly. We also endeavored to the examine correlation between serum ferritin and glycosylated ferritin in patients receiving regular blood transfusions.

Methods

We conducted a cross-sectional study involving 17 patients undergoing regular blood transfusions in the Department of Medical Oncology/Hematology, who had already received ≥10 transfusions without any iron chelation therapy or acute inflammation. All participants were evaluated based on a questionnaire to gather relevant medical details. Serum iron, ferritin, glycosylated ferritin, and unsaturated iron-binding capacity (UIBC) were estimated. Total iron-binding capacity (TIBC) and transferrin saturation were also calculated.

Results

Participants were divided into two groups based on transferrin saturation (≥50% as a reference for iron overload). The group with transferrin saturation ≥50% had significantly higher levels of serum ferritin, glycosylated ferritin, and iron, compared to the group with transferrin saturation <50%. Glycosylated ferritin showed a positive correlation with ferritin (rho=0.80) and transferrin saturation (rho=0.64), which was statistically significant. UIBC and TIBC showed a negative association with glycosylated ferritin. The correlation of glycosylated ferritin with units of blood transfusion (Spearman’s rho=0.60) was found to be better than that of serum ferritin (Spearman’s rho=0.52).

Conclusions

Based on our findings, glycosylated ferritin could be a potential marker for transfusion-related iron overload. The optimal cutoff value for iron overload using serum glycosylated ferritin level was >587.55 ng/mL. Further extensive studies with larger sample sizes will substantiate the role of glycosylated ferritin in predicting post-transfusion iron overload.