A Report on Chelating Therapy and Patient Compliance by Determination of Serum Ferritin Levels in 243 Thalassemia Major Patients

Background and Aim: This cross- sectional study was designed for determining the monthly serial serum ferritin levels and adequacy of Desferrioxamine usage in β-thalassemia major patients for roughly estimated outcome of compliance by subcutaneous Desferrioxamine chelation therapy.

Materials and Methods: In this study, 243 patients suffering from β-thalassemia major who had referred to the Thalassemia center affiliated to Ahvaz Jundishapur of Medical Sciences University, were investigated carefully and assessed for monthly serial serum ferritin levels. They received regular blood transfusions and follow ups were done in one year (Sept 1998 - Sept 1999).  Ferritin levels were measured by IRMA technique. Patients with a high serum ferritin level due to false positive causes were excluded from this study. Iron chelating treatment was started when serum ferritin levels was about 1000-1500 µg/lit. This usually occurred after the first 10-20 transfusions (nearly 3 years of age). It was prescribed for regular daily adjusted  dosage (subcutaneous, 25-50 mg/kg/24hr) over 8-12 hrs for administration at home. It was infused via a thin needle inserted subcutaneously and connected by an infusion line to a portable battery electrical infusion device. In selected heavily iron-load subjects, it was given via IV route in dose of 50 mg/kg/24hr, by short hospital admissions.

Results: Compliance adherence was observed only in 46 patients (18.2%, first group) with desirable serum ferritin levels less than 2000 µg/lit. Improved compliance adhesion was achieved in 78 patients (31.3%, second group) with unsatisfactory serum ferritin levels between 2000- 4000 µg/lit. Even though in this group the compliance adherence could be improved by close surveillance of Desferrioxamine infusions and intimate scrutiny by psychology intervention and social workers activity. In 119 patients (48.8%, third group) compliance was not achieved with serum ferritin levels more than 4000 µg/lit and more. These high risk patients were kept under evaluation by medical care through IV Desferrioxamine infusion and other medical treatments as needed and collaboration of social worker and psychology intervention.

Conclusion: Compliance adherence was achieved only in 18.2% of patients (first group) and compliance adherence was improved by close surveillance of Desferrioxamine infusions and psychology intervention and social workers activity in 31.3% (second group). Despite every day encouragement, compliance was not achieved in 48.8% (third group). Overall outcome was poor.