Clinical Research Of Iron Metabolism Indicators In Myelodysplastic Syndrome

Objective:From the point of view of the red blood cell iron metabolism,we investigate the change and disorder of iron metabolism indicators in myelodysplastic syndrome patients with bone marrow ineffective hematopoiesis.and to select aplastic anemia patients and normal people for the controls, it was analyzed that the characteristics and the clinical significance of abnormal iron metabolism in MDS patients, especially MDS patient without blood transfusions; At the same time we apply new indicators sTfR-E to evaluate the characteristics of bone marrow function and study its clinical value in MDS patients with ineffective hematopoiesis and the AA group.Methods:1、Clinical datas of38transfusion-independent MDS patients were collected from Department of Hematology, the Second Hospital of Shanxi Medical University with march to October in2012, selected21cases AA patients and28normals as a control group.They were diagnosed according to the "blood disease diagnosis and efficacy standards". Excluding autoimmune disease and other malignant diseases.2、The experimental group and the control group were further processed to levels detection of iron metabolism indicators on serum iron protein (SF), serum iron (SI), transferrin protein (Tf), total iron binding capacity (TIBC),transferrin saturation (TS),soluble transferrin receptor (sTfR).3、To observe the proportion and distribution of sideroblasts and extracellular iron under the microscope.4、To detect the chromosome karyotype of MDS patients by fluorescence in situ hybridization of, to analyse the difference of iron metabolism indicators in the low-risk group and in the high-risk group.5、To determine the bone marrow cellularity (vol%), bone marrow erythroblasts (%) and sTfR-E, sTfR-E=the ratio of serum sTfR levels (ng/ml) to [BM cellularity (%) X BM erythroblasts (%)].Results:1、The serum SF、SI and TS levels in MDS group was lower than the AA group,serum SF value is higher than the normal control group, there were not statistically significance compared to the normal group between in SI and TS levels, and SI, TS levels and SF levels are positively correlated (r=0.281, p=0.007; r=0.338, p=0.001). The serum TIBC levels in MDS group was not statistically significant compared with the control groups;The Tf levels in MDS group was higher than the AA and normal control group, and The latter two groups were not statistically significant.2、The proportion of sideroblasts in MDS group (57.19%±19.11%)was higher than the AA group (35.00±20.67%). The extracellular iron of24%MDS patients and33%A A patients are+++～++++; and bone marrow cell dyeable iron were observed mainly cocci-like distribution under the microscope in MDS group of them, but AA patients, small beads or massive distribution.3、In addition,15of19MDS cases(79%) of was abnormal in chromosome karyotype, there was no difference in iron metabolism Indicators between the high-risk group and the low-risk group of MDS. grouped according to the International Prognostic Scoring System WPSS.4、Serum sTfR level(1.99±0.53mg/L) in MDS group slightly higher than that that in AA group (1.68±0.53mg/L), there were statistical difference. However, that can be observed from the scatter plot sTfR values of two groups patients have more overlap than sTfR-E index of them; and the mean of bone marrow cellularity (%)and bone marrow erythroblasts (%)in MDS group were approximately2times than the AA group. After using sTfR-E index comparison and considering the affect of ineffective hematopoiesis, this index(16.29+14.39) of MDS group was lower than that ofAA patients (66.21+38.87), and it also can be seen overlap of the two groups to reduce from the scatter plot, there were statistical difference.Conclusion:Ineffective hematopoiesis in MDS patients lead that the iron loading degree high in SF, Tf, intracellular iron, extracellular iron. It indicates that the use、storage、intake and discharge of iron is abnormal in the erythroblasts and macrophage, related to Iron regulatory mechanisms irregular,otherwise,it indicates that AA patients were abnormal throughout the iron metabolism process. sTfR-E index together with factors of erythroblasts maturation degree and ineffective hematopoiesis, and indirectly reflects TfR level of the single erythroblast membrane. It can more real reaction of bone marrow proliferation degree and evaluation bone marrow hematopoiesis compared to sTfR indicators, and it has an important value in the differential diagnosis of AA and MDS.