ESTIMATION OF IRON OVERLOAD BY ORAL EXFOLIATIVE CYTOLOGY IN COMPARISON WITH SERUM AND SALIVA FERRITIN LEVELS IN BETA THALASSEMIA MAJOR PATIENTS RECEIVING MULTIPLE BLOOD TRANSFUSIONS

Abstract

Major cause of iron overload in beta thalassaemia major patients is blood transfusion therapy. Iron overload is inevitable as thalassaemia major patients take regular blood transfusion, because the human body does not have a mechanism for excess iron excretion. Exfoliative cytology is beneficial; as it noninvasive, quick, simple, painless, and bloodless procedure. Ferritin is the primary intracellular iron-storage protein that keep iron in non-toxic and soluble form, small amounts of ferritin are secreted into the plasma in the body. The concentration of this plasma (or serum) ferritin is correlate positively with the size of the total body iron stores in absence of inflammation. Saliva is one of the most important diagnostic body fluid that has significant logistical and biochemical advantages as compared to blood, considerable rise of salivary ferritin levels occur in iron overload disorders. The aims and objectives of this study were: 1.To estimate iron overload by oral exfoliative cytology using Perl’s Prussian blue stain in β-thalassemia major patients. 2. Assessment of iron overload (ferritin level) in serum and saliva of beta thalassemia major patients by ELISA. 3. To correlate perl’s Prussian blue staining positivity with their serum and saliva ferritin levels. Smears were obtained from buccal mucosa of 60 β-thalassemia major patients (who had taken ≥10 transfusions) and 30 healthy subjects of the same age group (6-26) year. Smears were stained with Perl’s Prussian blue stain kit. Blood and saliva samples were taken from the study and control group at the same time for estimation of serum and saliva ferritin levels. Grading criteria were defined for assessing the Prussian blue positivity. Perl’s positivity was observed in 48 out of 60 of thalassemic patients (80%), with a positive correlation to serum and saliva ferritin levels. Perl’s Prussian blue staining of exfoliated cells from buccal mucosa can be used to assess iron overload in β-thalassemia major patients.