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. 1982 May;35(5):487–491. doi: 10.1136/jcp.35.5.487

Effect of ascorbic acid deficiency on serum ferritin concentration in patients with beta-thalassaemia major and iron overload.

R W Chapman, M A Hussain, A Gorman, M Laulicht, D Politis, D M Flynn, S Sherlock, A V Hoffbrand
PMCID: PMC497702  PMID: 7085892

Abstract

The incidence of ascorbic acid (AA) deficiency and its effect on serum ferritin concentration relative to body iron stores was studied in 61 unchelated patients with beta-thalassaemia major. Thirty-nine (64%) of patients had subnormal leucocyte ascorbate concentrations without clinical evidence of scurvy. The lowest leucocyte ascorbate concentrations tended to occur in the most transfused patients. No correlation was found between the units transfused and serum ferritin concentration in the AA-deficient patients but a close correlation (r = +0.82; p less than 0.005) existed for the AA-replete group. Similarly a close correlation (r = +0.77; p less than 0.005) was obtained between liver iron concentration and serum ferritin in AA-replete patients but only a weak correlation (r = +0.385; p less than 0.025) existed for the AA-deficient group. When AA-deficient patients were treated with ascorbic acid, serum iron and percentage saturation of iron binding capacity rose significantly; serum ferritin rose in 13 of 21 patients despite the simultaneous commencement of desferrioxamine therapy. In contrast all three measurements tended to fall in AA-replete patients with ascorbic acid and desferrioxamine therapy. Thus, AA deficiency is commonly present in beta-thalassaemia patients with iron overload and may give rise to inappropriate serum ferritin concentrations in relation to body iron stores.

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Selected References

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  1. Addison G. M., Beamish M. R., Hales C. N., Hodgkins M., Jacobs A., Llewellin P. An immunoradiometric assay for ferritin in the serum of normal subjects and patients with iron deficiency and iron overload. J Clin Pathol. 1972 Apr;25(4):326–329. doi: 10.1136/jcp.25.4.326. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. BOTHWELL T. H., BRADLOW B. A., JACOBS P., KEELEY K., KRAMER S., SEFTEL H., ZAIL S. IRON METABOLISM IN SCURVY WITH SPECIAL REFERENCE TO ERYTHROPOIESIS. Br J Haematol. 1964 Jan;10:50–58. doi: 10.1111/j.1365-2141.1964.tb00677.x. [DOI] [PubMed] [Google Scholar]
  3. Barry M., Sherlock S. Measurement of liver-iron concentration in needle-biopsy specimens. Lancet. 1971 Jan 16;1(7690):100–103. doi: 10.1016/s0140-6736(71)90838-5. [DOI] [PubMed] [Google Scholar]
  4. Batey R. G., Hussein S., Sherlock S., Hoffbrand A. V. The role of serum ferritin in the management of idiopathic haemochromatosis. Scand J Gastroenterol. 1978;13(8):953–957. doi: 10.3109/00365527809181375. [DOI] [PubMed] [Google Scholar]
  5. Brissot P., Deugnier Y., Le Treut A., Regnouard F., Simon M., Bourel M. Ascorbic acid status in idiopathic hemochromatosis. Digestion. 1978;17(6):479–487. doi: 10.1159/000198154. [DOI] [PubMed] [Google Scholar]
  6. Cohen A., Cohen I. J., Schwartz E. Scurvy and altered iron stores in thalassemia major. N Engl J Med. 1981 Jan 15;304(3):158–160. doi: 10.1056/NEJM198101153040307. [DOI] [PubMed] [Google Scholar]
  7. DENSON K. W., BOWERS E. F. The determination of ascorbic acid in white blood cells. A comparison of W.B.C. ascorbic acid and phenolic acid excretion in elderly patients. Clin Sci. 1961 Oct;21:157–162. [PubMed] [Google Scholar]
  8. Hoffbrand A. V., Gorman A., Laulicht M., Garidi M., Economidou J., Georgipoulou P., Hussain M. A., Flynn D. M. Improvement in iron status and liver function in patients with transfusional iron overload with long-term subcutaneous desferrioxamine. Lancet. 1979 May 5;1(8123):947–949. doi: 10.1016/s0140-6736(79)91721-5. [DOI] [PubMed] [Google Scholar]
  9. Hussain M. A., Green N., Flynn D. M., Hoffbrand A. V. Effect of dose, time, and ascorbate on iron excretion after subcutaneous desferrioxamine. Lancet. 1977 May 7;1(8019):977–979. doi: 10.1016/s0140-6736(77)92279-6. [DOI] [PubMed] [Google Scholar]
  10. Hussein S., Laulicht M., Hoffbrand A. V. Serum ferritin in megaloblastic anaemia. Scand J Haematol. 1978 Mar;20(3):241–245. doi: 10.1111/j.1600-0609.1978.tb02453.x. [DOI] [PubMed] [Google Scholar]
  11. Letsky E. A., Miller F., Worwood M., Flynn D. M. Serum ferritin in children with thalassaemia regularly transfused. J Clin Pathol. 1974 Aug;27(8):652–655. doi: 10.1136/jcp.27.8.652. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Lipschitz D. A., Bothwell T. H., Seftel H. C., Wapnick A. A., Charlton R. W. The role of ascorbic acid in the metabolism of storage iron. Br J Haematol. 1971 Feb;20(2):155–163. doi: 10.1111/j.1365-2141.1971.tb07024.x. [DOI] [PubMed] [Google Scholar]
  13. Lynch S. R., Seftel H. C., Torrance J. D., Charlton R. W., Bothwell T. H. Accelerated oxidative catabolism of ascorbic acid in siderotic Bantu. Am J Clin Nutr. 1967 Jun;20(6):641–647. doi: 10.1093/ajcn/20.6.641. [DOI] [PubMed] [Google Scholar]
  14. Nienhuis A. W. Vitamin C and iron. N Engl J Med. 1981 Jan 15;304(3):170–171. doi: 10.1056/NEJM198101153040311. [DOI] [PubMed] [Google Scholar]
  15. Prieto J., Barry M., Sherlock S. Serum ferritin in patients with iron overload and with acute and chronic liver diseases. Gastroenterology. 1975 Mar;68(3):525–533. [PubMed] [Google Scholar]
  16. Walters G. O., Miller F. M., Worwood M. Serum ferritin concentration and iron stores in normal subjects. J Clin Pathol. 1973 Oct;26(10):770–772. doi: 10.1136/jcp.26.10.770. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Wapnick A. A., Bothwell T. H., Seftel H. The relationship between serum ion levels and ascorbic acid stores in siderotic Bantu. Br J Haematol. 1970 Aug;19(2):271–276. doi: 10.1111/j.1365-2141.1970.tb01624.x. [DOI] [PubMed] [Google Scholar]
  18. Wapnick A. A., Lynch S. R., Krawitz P., Seftel H. C., Charlton R. W., Bothwell T. H. Effects of iron overload on ascorbic acid metabolism. Br Med J. 1968 Sep 21;3(5620):704–707. doi: 10.1136/bmj.3.5620.704. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Worwood M., Cragg S. J., Jacobs A., McLaren C., Ricketts C., Economidou J. Binding of serum ferritin to concanavalin A: patients with homozygous beta thalassaemia and transfusional iron overload. Br J Haematol. 1980 Nov;46(3):409–416. doi: 10.1111/j.1365-2141.1980.tb05987.x. [DOI] [PubMed] [Google Scholar]
  20. Worwood M. Serum ferritin. CRC Crit Rev Clin Lab Sci. 1979;10(2):171–204. doi: 10.3109/10408367909147133. [DOI] [PubMed] [Google Scholar]

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