Severity of iron overload in patients with sickle cell disease receiving chronic red blood cell transfusion therapy.

Chronic transfusion therapy is being used more frequently to prevent and treat the complications of sickle cell disease. Previous studies have shown that the iron overload that results from such therapy in other patient populations is associated with significant morbidity and mortality. In this study we examined the extent of iron overload as well as the presence of liver injury and the predictive value of ferritin in estimating iron overload in children with sickle cell disease who receive chronic red blood cell transfusions. A poor correlation was observed between serum ferritin and the quantitative iron on liver biopsy (mean 13.68 +/- 6.64 mg/g dry weight; R = 0.350, P =.142). Quantitative iron was highly correlated with the months of transfusion (R = 0.795, P <.001), but serum ferritin at biopsy did not correlate with months of transfusion (R = 0.308, P =.200). Sixteen patients had abnormal biopsies showing mild to moderate changes on evaluation of inflammation or fibrosis. Liver iron was correlated with fibrosis score (R = 0.50, P =.042). No complications were associated with the liver biopsy. Our data suggest that, in patients with sickle cell disease, ferritin is a poor marker for accurately assessing iron overload and should not be used to direct long-term chelation therapy. Despite high levels of liver iron, the associated liver injury was not severe.

Production of enterotoxin A and thermonuclease by Staphylococcus aureus in legumes.

Growth, enterotoxin A (SEA) and thermonuclease (TNase) production of S. aureus (Strains CP 7 and FRI 722) was determined in media produced from the following heat or irradiation sterilized legumes: peas, black beans, mung beans, adzuki beans and soybeans. Media containing the five legumes alone or in combination with Brain Heart Infusion Broth (BHI) were tested. With the exception of heat-sterilized black beans and adzuki beans, S. aureus growth was excellent in all media with cell counts after 48 h (25 degrees C) exceeding 10(8) cfu/ml. In black beans and adzuki beans cell counts were 1-2 log-cycles lower. Enterotoxin A was produced in amounts of 33 to 72 ng/ml in BHI after 48 h. Almost no toxin was produced in the four different beans following heat or irradiation treatment; in peas the toxin concentration reached 14 to 15 ng/ml. In the medium prepared from irradiated soybeans and BHI the final toxin concentration was about the same as in BHI alone. In all the other media consisting of a combination of legumes with BHI toxin concentrations were three to four times higher than in BHI alone. Production of thermonuclease showed variation and did not always correlate with enterotoxin production.