[Determinants for iron overload in patients with acute leukemias and aplastic anemia].

AIM: to reveal the determinants of the development of iron overload in patients with acute leukemias (AL) and aplastic anemia (AA). SUBJECTS AND METHODS: The investigation included 104 patients, including 64 with various types of AL, 31 with AA, and 9 with myelodysplastic syndromes (MDS). A group affiliation and an erythrocyte phenotype were determined from rhesus system antigens in all the patients and the HFE gene was studied to identify mutations. For control of siderosis, the authors determined serum iron (SI) by a colorimetric technique, by applying the kits of the AGAT firm (Russia), serum ferritin (SF) by an immunoradiometric method, by using the kits of Immunotech (Czechia). The volume of transfusion was estimated in the period of June 2007 to November 2009. RESULTS: There is evidence for a relationship between the higher level of SF and the number of transfusions. SF was 1046.1 microg/l in patients, H63D heterozygous carriers who had received less than 10 packed red blood cell transfusions and 2856 microg/l in those who had 20 transfusions (p < 0.005). HFE gene mutation carriage accelerates iron accumulation and is an additional risk factor for siderosis. In patients with transfusion chimeras and a rare phenotype in terms of rhesus antigens, packed red blood cell transfusion results in a much more increase in iron stores. CONCLUSION: The most important factor of iron overload acceleration is no specific choice of packed red blood cells for patients with rare combinations of red blood cell antigens and for those with artificially induced chimeras.

[Value of dynamic study of cytokines in serum and leukocytes in patients with acute leukemia].

A number of interleukins and iron metabolic parameters were studied in acute leukemia over time. Regulation of hemopoiesis and the cytokine network has been found to be impaired, which appears as the increased synthesis of ferritin and hepsidin by macrophages that are activated by imbalance in the cytokine network. A severe impairment of the parameters responsible for a regulatory process is shown to occur in leukemia. There is no complete normalization of these parameters during hematological remission, which is likely to lead to a further relapse of leukemic process.

[Clinical significance of determining the soluble transferrin receptor]. / Klinicheskoe znachenie opredeleniia rastvorimogo transferrinovogo retseptora.

The aim of the study was to work out a method for determining the soluble transferrin receptor (TfR) on the basis of the direct immune-enzyme analysis, including its dynamic testing in patients with anemia of various etiologies. Reagents, needed for the above analysis, i.e. TfRs and antibodies to them, were obtained to implement the set goal. TfR was isolated by Kanevsky's affine chromatography from the homogenate of patients. The thus isolated TfR was used to immunize and to obtain the monoclonal antibodies. The conjugate of horseradish peroxidase (HP) and antibodies to TfR were made use of to determine the quantity of bound antibodies. One type of antibodies were immobilized in plates of the "Nunk" company (Denmark), and the other type of monoclonal antibodies were conjugated with HP. A reliably higher TfR in iron-deficiency anemia was shown during the determination of the TfR level in 36 donors and 266 patients. After a conducted ferrotherapy, the TfR level went down approaching the normal value. The TfR level was related with a disease stage and activity of the prolipherative process in cases of autoimmune hemolytic anemia, B12-folate-dependent anemia, lympho- and myeloprolipherative diseases and in oncology patients. The elaborated method opens up new possibilities for the differential diagnosis of anemia and provide for objective criteria of a conducted therapy.

[Clinical significance of erythrocyte ferritin in refractory anemia and chronic myeloid leukemia]. / Klinicheskoe znachenie ferritina éritrotsitov pri refrakternykh anemiiakh i khronicheskom mieloleikoze.

AIM: To find out if the RBC ferritin elevation can serve as an additional criterion of inefficient erythropoiesis during progression of chronic myeloid leukemia (CML) and in various types of refractory anemia. MATERIAL AND METHODS: The study group consisted of 56 MDS patients and 73 patients at various stages of CML. 20 healthy donors and 105 patients with verified inefficient erythropoiesis (20--with B12 deficiency before and after the treatment, 85--with beta-thalassemia) were the controls. A ferritin level was measured by radioimmunoassay in RBC hemolysates. RESULTS: The RBC ferritin level in all types of refractory anemia was elevated throughout the disease course, increasing with the development of transfusion dependency. The CML progression was also accompanied by RBC ferritin level elevation associated with abnormal erythroid cell accumulation and elevation of intracellular PAS-positive substance (p < 0.05). CONCLUSION: RBC ferritin level elevation can be considered as an additional biochemical criterion of inefficient erythropoiesis that may be useful in differentiation of anemias, adequate therapy selection and follow-up of erythropoiesis.

[Indices of iron metabolism in liver homogenates and leukocytes]. / Opredelenie pokazatelei obmena zheleza v gomogenatakh pecheni i leikotsitov.

Iron metabolites were measured in liver homogenates and leukocytes of patients with hereditary hemochromatosis (HHC), chronic viral hepatitis, and secondary iron overloading. Iron and ferritin levels in the liver are increased HHC, while in hepatitis only ferritin level is increased. In the leukocytes ferritin concentrations are increased both in HHC and secondary iron loading and less so in viral hepatitis. The leukocytic ferritin level decreased after a course of bleeding sessions and during maintenance therapy for HHC, which can serve as a diagnostically significant sign for evaluating the treatment efficiency.

[Change in iron metabolism as affected by ionizing radiation]. / Izmenenie metabolizma zheleza pod deistviem ioniziruiushchei radiatsii.

Iron metabolism parameters (increased level of serum ferritin, appearance of an iron pool specifically unrelated to transferrin, reduced ceruloplasmin level, etc.) were found changed in subjects who participated in liquidation of Chernobyl power plant accident aftereffects. These shifts in iron metabolism are explained by reduced antioxidant activity of plasma and indicative of mononuclear phagocyte dysfunction, thus necessitating a dynamic monitoring of this population.

[Lymphocyte chemiluminescent activity under an iron overload of the body]. / Khemiliuminestsentnaia aktivnost' limfotsitov pri peregruzke organizma zhelezom.

Hyperferremia is shown to affect antioxidant system of the body, oxidation-reduction reactions in the cells seen as shifts in lymphocyte chemiluminescence. Dynamic changes in lymphocyte chemiluminescence reflect the level of hyperferremia.

[Indicators of iron metabolism in pregnant women and infants]. / Pokazateli metabolizma zheleza u beremennykh zhenshchin i detei rannego vozrasta.

Iron metabolism parameters were studied in pregnant women in time course of trimesters depending on the pregnancy character and in newborns and infants in relation to the antenatal period. The dynamic study of serum and erythrocytic ferritins has confirmed the expediency of iron therapy during pregnancy for prevention of iron deficiency in infants. Differences detected in the rate of using iron reserves by infants of the first year of life depending on the antenatal period character have necessitated an individual approach to preventive iron therapy.

[Transferrin iron-binding capacity in hypersideremia]. / K voprosu ob obshchei zhelezosviazyvaiushchei sposobnosti transferrina pri gipersideremiiakh.

Three methods for evaluation of serum iron-binding capacity have been described: biochemical, immunological based on transferrin assay, and biophysical based on electron-paramagnetic resonance (EPR) spectroscopy of transferrin. Interrelation has been shown between transferrin and general serum iron-binding capacity. Basing on the data presented it is suggested that in secondary hemochromatosis plasma contains an iron pool that is not specifically bound with transferrin, while in primary hemochromatosis such pool was not detected.

[Iron metabolism in anemia patients with no deficiency of iron reserves]. / Osobennosti obmena zheleza u bol'nykh s anemiei, protekaiushchei bez defitsita zapasov zheleza.

Iron metabolism was studied in anemia patients with no iron deficiency. The data obtained have suggested that iron transport to blood-synthesizing cells i disturbed in such patients with normal iron reserves. Basing on the study of iron metabolism and red blood parameters in the patients after the treatment by hypoxic hypoxia it is shown that this method combined with iron therapy can be successfully used for the treatment of this form of iron deficiency anemia.

[Diagnostic value of serum iron metabolism parameters in patients with malignant and reactive histiocytosis]. / Diagnosticheskoe znachenie syvorotochnykh pokazatelei obmena zheleza u bol'nykh zlokachestvennym i reaktivnymi gistiotsitozami.

Difficulties in the morphological diagnosis of the diseases due to proliferation of mononuclear phagocyte system (MPS) cells have stimulated the search for additional differential-diagnostic criteria. The investigations were conducted in 10 malignant histiocytosis, 16 histiocytosis-X, and 34 reactive histiocytosis patients. The assay of serum ferritin was shown to have high informative value for clinical practice. The presence of extremely high hyperferritinemia in patients with morphologically verified histiocytic proliferations has evidenced a malignant character of the process.

[Antioxidant activity of blood serum amd erythrocytes in patients with refractory anemia]. / Antioksidantnaia aktivnost' syvorotkii éritrotsitov u bol'nykh refrakternymi anemiiami.

Iron metabolism was studied in patients with refractory anemia. It is shown that continuous transfusions of erythrocytes result in a sharp rise of iron reserves that plays an important role in the development of hemosiderosis. To prevent iron oxidative action it is recommended that the patients should be subjected to therapy with chelating agents and antioxidants simultaneously with transfusions of erythrocytes. A relationship has been noted between blood antioxidant capacity decrease and iron-overloading.

[Study of iron metabolism in chronic diffuse diseases of the liver]. / Izuchenie metabolizma zheleza pri khronicheskikh diffuznykh zabolevaniiakh pecheni.

Iron metabolism was studied in patients with chronic diffuse diseases of the liver. A sharp increase of ferritin content at the expense of its release from affected hepatocytes, and formation of antibodies to ferritin of the splenic type have been recorded in patients with cirrhosis of the liver. The observed growth of ferritin content in red blood cells can be explained by functional deficiency of red blood cells and by the presence of hemolytic process (twofold decrease of haptoglobin level). A conclusion has been made that ferritin content in the blood serum does not correlate with the total iron reserves, and serum ferritin level should be considered not as a sign of the pathologic process, but as an index of iron reserves capable of participating in metabolic processes.

[Iron metabolism in hereditary hemochromatosis]. / Metabolizm zheleza pri nasledstvennom gemokhromatoze.

The characteristic features of iron metabolism in hereditary hemochromatosis are described. The patients showed an increase of serum iron, iron saturation of transferrin as well as serum ferritin and erythrocytes. Results of determination of isoferritins of the splenic and cardiac types revealed a biochemical heterogeneity of hereditary hemochromatosis. Methods of differential diagnosis of hereditary hemochromatosis, secondary hemochromatosis and chronic diseases of the liver are described.