Renal iron load in sickle cell disease is influenced by severity of haemolysis

Summary Spin density projection‐assisted R 2‐magnetic resonance imaging ( R 2‐ MRI ; F erriScan ® ) scans from 40 chelation‐naïve sickle cell patients were used to assess renal iron load by measuring renal R 2 ( R ‐ R 2). Clinical data were collected retrospectively for the 2‐year period preceding the scan. R ‐ R 2 showed no significant correlation with transfusional iron load (assessed by liver iron concentration), but correlated significantly with serum bilirubin ( R  = 0·61, P  < 0·0001) and lactate dehydrogenase ( R  = 0·58, P  < 0·0001). Mean (±standard deviation) R ‐ R 2 was higher ( P  = 0·02) in patients with renal hyperfiltration (29·8 ± 10·3/s) than those without (23·11 ± 6·6/s). Five patients had significantly lower signal intensity in the renal cortex, as compared to the medulla. These patients had a significantly higher ( P  < 0·0001) mean R ‐ R 2 than those showing no cortico‐medullary difference. We postulate that the increased R ‐ R 2 is associated with haemolysis rather than transfusional iron load in sickle cell disease.