C- Reactive protein and iron status in Iraqi patients with acute myeloid leukemia before and after treatment


Background: Acute Myeloid Leukemia (AML) is a clonal hematopoietic disorder, leading to apremature arrest of the normal differentiation of stem cells. C - reactive protein (CRP) is a markerof inflammation. Serum level of C-reactive protein may be increase in patients with AML. Thisassociation between CRP levels and acute myeloid leukemia influenced by multiple factors.Acute myeloid leukemia commonly associated with iron overload. Many factors are participatingto the hyperferritinemia associated with AML, inflammation chemotherapy, blood transfusionand ferritin hepatic clearance disordersObjectives: To assess serum C-reactive protein (CRP) and iron status (serum Iron, Total ironbinding capacity, serum ferritin levels) in patients with acute myeloid leukemia (AML) beforeand after chemotherapyMaterials and Methods: A prospective cohort study included 58 patients (30 male and 28female) with acute myeloid leukemia with age range (15-65 years). Patients divided into twogroups: Group (1) Patients with AML before starting chemotherapy. Group (2) the patients after 4weeks of chemotherapy In addition to 43 healthy subjects (24 male and 19 female) wereincluded. They were age and sex matched to patients group and considered as controls as(Group 3). This study conducted at the National Center of Hematology and Baghdad TeachingHospital in the Medical City from February 2014 to June 2014. All patients were subjected tocomplete history and physical examination. Diagnosis as AML patients was established bycomplete blood count and blood film, bone morrow aspiration and biopsy. C-reactive proteins.iron, s.total iron binding capacity and s. ferritin were estimated for all .Results: Serum CRP levels increased in AML patients before and after treatment , while therewere a significant increase in mean serum ferritin levels observed in (Group 2) compared tonewly diagnosis patients (Group 1)(P<0.002) and the levels were significantly higher in newlydiagnosis group compared to healthy controls (P<0.015). Patients with (AML) during remissionshow significant decrease in iron levels compared to newly diagnosis group (P<0.0001), whilelevels in healthy controls recorded higher values than both (Group 2) and (Group 1) (P<0.0001).Serum total iron binding capacity (TIBC ) levels showed a significant decrease in (Group 2) aftertreatment compared to (Group 1) before treatment(P<0.0001) but the levels were significantlyhigher in healthy controls compared to (Group 1) and (Group 2) (P<0.0001)Conclusion: CRP does not predict response to chemotherapy while it may be of benefit inpredicting infection or inflammation in patient with AML post chemotherapy. Regarding Ironstatus: s.ferritin increase significantly post chemotherapy while s.iron and TIBC decrease.


CRP, iron status, AML