The Effects Of Iron Overload On The Bone Marrow Hematopoietic Function Of Immuo-related Pancytopenia Patients

Objective To investigate the hematopoietic progenitor cell(HPC) proliferation, blood cell counts, bone marrow(BM)proliferation, blood transfusion, treatment effects and multiple organ function indexes of immuo-related pancytopenia (IRP) patients, then explore the effect of iron overload on the bone marrow hematopoietic function and essential organ functions of IRP patients.Methods 154 cases of IRP were enrolled in this study. The effects of iron overload on blood cell counts, BM proliferation, blood transfusion, treatment effects and multiple organ function indexes were analyzed. In the 154 cases,46 patients'BMs were taken to detect colony-forming-unit of erythrocyte (CFU-E), blast-forming-unit of erythrocyte (BFU-E), colony-forming-unit of granulocyte-monocyte (CFU-GM) by HPC culture. Then according to the serum ferritin (SF) level, we classified these 46 patients into 2 groups to compare HPC proliferation and its correlation with SF.Results 1. The mean values of 3 different colonies of IRP patients with high SF level [(43.33±17.74),(1.50±2.2),(11.06±5.83)/105BMMNC] were significantly lower than those with normal SF level [(77.43±40.64),(9.57±7.99), (21.25±11.41)/105BMMNC] (P＜0.01). And the SF level was negatively correlated with CFU-E, BFU-E, CFU-GM colonies (r=-0.441, p=0.002; r=-0.475, p=0.001; r=-0.496, p=0.000).2. The patients with high SF level had significantly lower Hb level, ANC counts and PLT counts[(60.25±16.49)g/L,0.90×109/L,14.0×109/L] before treatment than the patients with normal SF level[(86.65±24.12)g/L,1.23×109/L, 32.0×109/L](p＜0.05).3. The recovery of peripheral blood cell:①The patients with high SF level had significantly lower Hb level before treatment, at 1,3,6 months and 1 year after treatment[(60.25±16.49), (65.73±18.76), (72.27±26.45), (81.00±31.33), (94.32±36.28)g/L] than the patients with normal SF level[(86.65±24.12), (88.49±28.39), (100.14±27.02), (107.73±25.51), (113.65±22.86)g/L](p＜0.05).②The patients with high SF level had significantly lower ANC counts before treatment, at 1 month and 2 year after treatment[(0.9,4.07,1.96)×109/L] than the patients with normal SF level[(1.23,6.04,3.41)×109/L](p＜0.05).③The patients with high SF level had significantly lower PLT counts before treatment, at 1,3,6,9 months and 1,2,3 years after treatment[(14.0,35.17,24.9,39.13, 38.65,40.24,49.25,59.20)×109/L] than the patients with normal SF level[(32.0, 72.5,82.85,75.59,100.02,108.79,108.43,140.38)×109/L](p＜0.05).4. Bone marrow proliferation (sternum/iliac):①The patients with high SF level had significantly lower bone marrow cellularlty of sternum and iliac than the patients with normal SF level(p<0.05).②The patients with high SF level had significantly lower granulocytes, erythrocytes and megalcaryocytes in sternum and iliac BM[(39.55±14.61)/(35.45±14.14)%,38.5/16.5%,6.0/0.0] than the patients with normal SF level[(44.31±13.44)/(40.92±16.08)%,32.0/21.5%,19.0/6.0](p＜0.05).③The degree of marrow iron-stain of patients with high SF level was higher than the patients with normal SF level(p<0.05).5. Essential organ function injury:①The patients with high SF level had significantly higher incidence of abnormal liver function than the patients with normal SF level(66.2% vs 13.5%)(p=0.000).②The patients with high SF level had significantly higher incidence of abnormal renal function than the patients with normal SF level(41.5% vs 11.2%)(p=0.000).③The patients with high SF level had significantly higher incidence of abnormal electrocardiogram(ECG) than the patients with normal SF level(58.5% vs 16.9%)(p=0.000).④The patients with high SF level had significantly higher incidence of blood glucose elevation than the patients with normal SF level(46.2% vs 11.2%)(p=0.000).⑤The patients with high SF level had significantly higher incidence of infection than the patients with normal SF level(56.9% vs 15.7%)(p=0.000).6. Blood transfusion①The patients with high SF level had significantly higher incidence of blood transfusion than the patients with normal SF level(83.1% vs 27.0%)(p=0.000).②The units of RBC and PLT transfused of high SF level patients were significantly higher than those with normal SF level(Z=-7.114,p=0.000; Z=-6.504, p=0.000). And the SF level was positively correlated with the units of RBC and PLT transfused(r=0.560, p=0.000; r=0.510, p=0.000).7. The patients with high SF level had significantly lower total effective rate than the patients with normal SF level (43.1% vs75.3%) (P=0.002). And the SF level was negatively correlated with treatment effects(r=-0.326, p=0.000).Conclusion Iron overload can reduce the bone marrow hematopoietic function and treatment effects and cause multiple organ function injury in IRP. And the higher SF level, the worse function and treatment effects. Thus, we should dynamicly monitor the SF level and control blood transfusion of IRP patients to protect them from being with iron overload and increase their therapy response.