Children with leukemia commonly receive red blood cell (RBC) transfusions and transfusion-related iron overload (TRIO) is a major complication. However, few studies have evaluated TRIO in children with leukemia and no guidelines for screening exist. This retrospective, observational cohort study in children with acute leukemia evaluates the prevalence of TRIO and its impact on end-organ function.

The study included 139 patients; 60% standard-risk acute lymphoblastic leukemia (ALL), 32% high-risk (HR) ALL, and 9% acute myeloid leukemia (AML). The mean age at diagnosis was 6 years (range: 5 mo to 18 y). Patients with HR-ALL and AML were more likely to be transfused with ≥10 RBC units (59% and 92%, respectively) compared with those with standard-risk ALL (18%) (P<0.0001). Ferritin levels were measured in 68% patients and elevated (>1000 mcg/L) in 23%. Endocrinopathies were the most common end-organ abnormality. Hepatic dysfunction was significantly higher in patients with ≥10 RBC units transfused compared with those with <10 units (P=0.008).

Although the RBC transfusion burden is highest in patients with AML and HR-ALL, TRIO screening was not commonly performed. Patients who receive ≥10 RBC units are at risk for hepatic and endocrine dysfunction. We recommend routine screening for TRIO in children with leukemia, who are at risk for a higher transfusion burden.