Reversibility of cardiac iron load in thalassemic patients: a clinical pathology study

In a group of 8 thalassaemic patients with different grades of cardiac siderosis and immunohistochemical ferritin expression grades, histologically demonstrated by endomyocardial biopsy (EMB), a second biopsy was performed after more than a year of intravenous iron chelation therapy. The aim of the work was to asses the evolution of thalassaemic heart disease by histochemical and immunohistochemical methods, after an adequate chelation therapy, and to demonstrate the histochemical modifications to tissue iron, the immunohistochemical modifications to myocardial ferritin and the reversibility of the iron induced organ damage. Seven of the eight patients assessed were normal; no iron accumulation or myocardial ferritin positivity was detected. Our study demonstrates that appropriate iron chelation therapy removes iron deposits from the myocardium and leads to a complete reversal of its storage. At a clinical level these results lead to an improvement in the quality of life and we could hypothesise a prolongation of life expectancy.