Demonstration of iron in exfoliated buccal cells of β-thalassemia major patients

Background: Thalassemia is a genetic disorder of hemoglobin synthesis, which requires regular blood transfusion therapy leading to iron overload in the body tissues. Transfusional hemosiderosis is a major cause of morbidity and mortality in these patients. Reliable methods for evaluation of iron overload are either invasive, costly or remotely available. Therefore, a simple technique of monitoring iron overload is desirable. Aim: To know whether iron can be demonstrated in exfoliated buccal cells of beta-thalassemia major patients using Perls' Prussian blue method and to correlate it with serum ferritin levels. Materials and Methods: Smears were obtained from buccal mucosa of 60 randomly selected beta-thalassemia major patients and 30 healthy subjects as controls. Smears were stained with Perls' Prussian blue method. Blood samples were taken for estimation of serum ferritin levels. Statistical Analysis: Chi-square, Mann-Whitney, and Spearman Rank's Correlation tests. Results: Perls' positivity was observed in 71.7% of thalassemic patients with a moderately positive correlation to serum ferritin levels. Conclusion: Oral exfoliative cytology can be a useful tool in demonstration of iron overload in thalassemic patients, however, further research in this field in the direction of quantification of these procedures is required, which can establish this non-invasive procedure as an ideal screening tool.