[Quantification of iron overload].

Abstract

Iron overload involves primarily hepatocytes in case of digestive hyperabsorption (hemochromatosis and dyserythropoiesis) and macrophages in case of transfusional excess. Serum iron and transferrin saturation are poorly correlated with the degree of iron overload. Serum ferritin is a better reflect of iron stores but numerous clinical conditions, unrelated to variations of iron load, can increase the serum level. Biochemical determination of liver iron overload is the gold standard of iron quantification and well correlated to the level of iron burden appreciated by the amount of iron removed by venesection, but its determination necessitates a liver biopsy and is dependant of sampling error in case of heterogeneous iron deposits (cirrhosis). The sensitivity of computed tomography is insufficient, beeing unable to detect iron overload below 5 times the normal liver iron load, especially in case of associated steatosis. Magnetic resonance imaging is a valuable tool when using T2 weighted gradient echo sequences on 1.5 Tesla magnet and permits non invasive iron overload quantification.