P0455 - Clinical Associations in Pediatric ECLS patients with Elevated Iron Markers

Elevated serum ferritin, or hyperferritinemia, is frequently used as a surrogate to represent iron overload in patients who undergo chronic transfusions. Recently, increased ferritin and iron levels have been found in pediatric Extracorporeal Life Support (ECLS) patients. While elevated ferritin may represent an acute inflammatory phase reactant alone, it can also represent both acute or chronic iron overload due to large volume or chronic transfusion. Recognition of iron overload is crucial because when untreated it can lead to iron deposition in solid organs throughout the body causing multiorgan dysfunction and toxicity, including but not limited to cardiomyopathy, endocrinopathy, renal dysfunction, hepatotoxicity, and neurotoxicity.

This observational pilot study aims to describe dynamic changes in iron metabolism biomarkers in pediatric patients undergoing ECLS. We hypothesize that ECLS duration, modality, and transfusion patterns correlate with serum ferritin and iron changes during ECLS. All variables were serially measured and prospectively collected.

We describe eight cases of pediatric ECLS support of varying age, indication, and duration. Case descriptions including ECLS duration, modality, cumulative transfusion, and circuit event history were compared to the changes in obtained biomarkers (Table 1). All patients except one had an abnormally elevated ferritin throughout the duration of ECLS. Age under 60 days of life at cannulation was associated with increased average serum ferritin (p=0.03) and serum iron (p=0.004). Interestingly, veno-arterial cannulation was also associated with significantly higher serum ferritin (p=0.05). Average serum iron values were increased with duration beyond 72 hours (p=0.03), daily packed red blood cell (pRBC) transfusion of greater than 15mL/kg/day (p=0.05) or cumulative pRBC transfusion greater than 100mL/kg (p =0.03) (Figure 1).

Based on early observations, pediatric patients may be exposed to iron overload during ECLS. Identifying potential risk factors for elevated ferritin and iron such as veno-arterial support, ECLS duration, and cumulative transfusion exposure may influence future management and therapeutic options during ECLS. Further investigation is warranted regarding elevations in serum iron and organ deposition.