skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: Rapid excretion of gallium-67 isotope in an iron-overloaded patient receiving high-dose intravenous deferoxamine

Abstract

A 23 year-old black male with homozygous sickle cell disease (Hb SS disease) and transfusional iron overload was admitted for evaluation of response to intravenous deferoxamine (DFO) therapy. Soon after admission, the patient suffered an intraventricular hemorrhage and during his subsequent hospitalization developed a persistent fever of undetermined origin (f.u.o.). Included in the diagnostic evaluation of fever was a gallium 67 scan (Ga-67), which was initially nondiagnostic because of Ga-67 citrate's preferential chelation by DFO. After DFO was discontinued, a repeat scan demonstrated a lesion above the left kidney. To our knowledge the unusual interaction in vivo of DFO with Ga-67 citrate has not been reported in the clinical literature. With the anticipated increased use of chelation therapy for patients with transfusional iron overload, this interaction may be encountered more frequently. DFO should be discontinued before the use of Ga-67 scanning in this clinical situation, or an alternative isotopic scan, such as indium-labelled white cells, should be considered.

Authors:
;
Publication Date:
Research Org.:
Children's Hospital of Philadelphia, PA (USA)
OSTI Identifier:
6579696
Alternate Identifier(s):
OSTI ID: 6579696
Resource Type:
Journal Article
Resource Relation:
Journal Name: Am. J. Hematol.; (United States); Journal Volume: 29:4; Journal Issue: 4
Country of Publication:
United States
Language:
English
Subject:
63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.; 62 RADIOLOGY AND NUCLEAR MEDICINE; DEFEROXAMINE; BIOCHEMICAL REACTION KINETICS; GALLIUM 67; METABOLISM; ANEMIAS; CITRATES; DATA COVARIANCES; FEVER; HEMORRHAGE; INTRAVENOUS INJECTION; IRON; PATIENTS; RADIOISOTOPE SCANNING; TRANSFUSIONS; AMINES; BETA DECAY RADIOISOTOPES; CARBOXYLIC ACID SALTS; CHELATING AGENTS; COUNTING TECHNIQUES; DAYS LIVING RADIOISOTOPES; DISEASES; ELECTRON CAPTURE RADIOISOTOPES; ELEMENTS; GALLIUM ISOTOPES; HEMIC DISEASES; INJECTION; INTAKE; INTERMEDIATE MASS NUCLEI; ISOTOPES; KINETICS; METALS; NUCLEI; ODD-EVEN NUCLEI; ORGANIC COMPOUNDS; PATHOLOGICAL CHANGES; RADIOISOTOPES; REACTION KINETICS; SYMPTOMS; THERAPY; TRANSITION ELEMENTS 560161* -- Radionuclide Effects, Kinetics, & Toxicology-- Man; 550601 -- Medicine-- Unsealed Radionuclides in Diagnostics

Citation Formats

Baker, D.L., and Manno, C.S. Rapid excretion of gallium-67 isotope in an iron-overloaded patient receiving high-dose intravenous deferoxamine. United States: N. p., 1988. Web. doi:10.1002/ajh.2830290411.
Baker, D.L., & Manno, C.S. Rapid excretion of gallium-67 isotope in an iron-overloaded patient receiving high-dose intravenous deferoxamine. United States. doi:10.1002/ajh.2830290411.
Baker, D.L., and Manno, C.S. Thu . "Rapid excretion of gallium-67 isotope in an iron-overloaded patient receiving high-dose intravenous deferoxamine". United States. doi:10.1002/ajh.2830290411.
@article{osti_6579696,
title = {Rapid excretion of gallium-67 isotope in an iron-overloaded patient receiving high-dose intravenous deferoxamine},
author = {Baker, D.L. and Manno, C.S.},
abstractNote = {A 23 year-old black male with homozygous sickle cell disease (Hb SS disease) and transfusional iron overload was admitted for evaluation of response to intravenous deferoxamine (DFO) therapy. Soon after admission, the patient suffered an intraventricular hemorrhage and during his subsequent hospitalization developed a persistent fever of undetermined origin (f.u.o.). Included in the diagnostic evaluation of fever was a gallium 67 scan (Ga-67), which was initially nondiagnostic because of Ga-67 citrate's preferential chelation by DFO. After DFO was discontinued, a repeat scan demonstrated a lesion above the left kidney. To our knowledge the unusual interaction in vivo of DFO with Ga-67 citrate has not been reported in the clinical literature. With the anticipated increased use of chelation therapy for patients with transfusional iron overload, this interaction may be encountered more frequently. DFO should be discontinued before the use of Ga-67 scanning in this clinical situation, or an alternative isotopic scan, such as indium-labelled white cells, should be considered.},
doi = {10.1002/ajh.2830290411},
journal = {Am. J. Hematol.; (United States)},
number = 4,
volume = 29:4,
place = {United States},
year = {Thu Dec 01 00:00:00 EST 1988},
month = {Thu Dec 01 00:00:00 EST 1988}
}
  • A new efficient method has been developed for the labeling of various biologically important proteins with radiogallium, using deferoxamine (DF) as a bifunctional chelating agent. Human serum albumin (HSA) was chosen for studying the DF coupling reaction by a glutaraldehyde two-step method. The DF-HSA conjugate obtained was then easily labeled with Ga-67 with high efficiency and reproducibility. High stability of the Ga-67 DF-HSA was observed both in vitro and in vivo. In rats the half-time of blood clearance at the first phase was 234 min for the Ga-67 DF-HSA, whereas most conventional I-131 HSA gives 121 min. The excellent pharmacologicalmore » and physiological properties were assessed by plasma clearance and plasma volume measurements in normal volunteers. Even at 2 hr after iction, (90.0 +/- 3.0)% of Ga-67 DF-HSA was retained within the vascular space. The mean plasma volume per kilogram of body weight, measured with Ga-67 DF-HSA, was 46.6 +/- 3.4 ml/kg, compared with 52.2 +/- 2.4 ml/kg as determined with I-131 HSA in the same men.« less
  • A new efficient method has been developed for the labeling of various biologically important proteins with radiogallium, using deferoxamine (DF) as a bifunctional chelating agent. Human serum albumin (HSA) was chosen for studying the DF coupling reaction by a glutaraldehyde two-step method. The DF-HSA conjugate obtained was then easily labeled with Ga-67 with high efficiency and reproducibility. High stability of the Ga-67 DF-HSA was observed both in vitro and in vivo. In rats the half-time of blood clearance at the first phase was 234 min for the Ga-67 DF-HSA, whereas most conventional I-131 HSA gives 121 min. The excellent pharmacologicalmore » and physiological properties were assessed by plasma clearance and plasma volume measurements in normal volunteers. Even at 2 hr after injection, (90.0 +/- 3.0)% of Ga-67 DF-HSA was retained within the vascular space. The mean plasma volume per kilogram of body weight, measured with Ga-67 DF-HSA, was 46.6 +/- 3.4 ml/kg, compared with 52.2 +/- 2.4 ml/kg as determined wih I-131 HSA in the same men.« less
  • Deferoxamine mesylate (DFO), given to rabbits 20 min after gallium-67 citrate, induces prompt and rapid urinary excretion of Ga-67 activity with concommitant decrease in blood and muscle activity. When DFO is given after 2 hr or later, the effect is smaller (15% decrease in blood activity compared with 50%). In abscess-bearing rats the same effect was observed: DFO accelerated the Ga-67 blood clearance by increasing urinary excretion. Tissue-distribution studies and direct counting of abscesses showed that DFO lowers Ga-67 activity in all organs as well as in the abscess if given 2 or 4 hr after Ga-67, citrate, but themore » abscess-to-blood ratio increases. At 24 hr after Ga-67 citrate, DFO administration causes an improvement in the ratios of abscess-to-blood and abscess-to-normal tissue. Thus, DFO could be used to decrease the radiation burden from Ga-67 citrate after imaging has been performed, and also to increase the target-to-nontarget ratio.« less
  • Radiogallium (Ga) labeling of an immunoglobulin-G-deferoxamine conjugate (DF-IgG) to a high-specific radioactivity was performed to allow the development of a radiometallic immunoradiometric assay (IRMA) system. To increase the specific radioactivity of Ga-DF-IgG, we used dialdehyde starch (DAS) as a multi-site spacer for the binding of DF to IgG. Six DF molecules bound to each IgG molecule after DAS conjugation. DF-DAS-IgG was then labeled with the previously reported {sup 67}Ga labeling solution, producing labeled IgG with a specific radioactivity of 11,766 MBq/mg IgG. Using this method, we labeled an anti-CA125 tumor-associated antigen monoclonal antibody (130-22), allowing the first application of {supmore » 67}Ga-DF-DAS-IgG to an IRMA system. With this system, a higher sensitivity could be obtained than with {sup 125}I IRMA. In addition, a very high correlation (r = 0.995) was obtained between serum CA125 levels as determined by {sup 67}Ga IRMA and {sup 125}I IRMA. Gallium-67-labeled antibodies with a high-specific radioactivity appear to hold promise for use in highly sensitive radioassay systems.« less
  • The contrast-enhancing properties of iron (Fe) and deferoxamine (DFO) in abscess imaging with Ga-67 citrate were compared in rats bearing turpentine-induced abscesses. Iron administration shifted Ga-67 from plasma into tissues such as muscle and fat. As a result, the abscess-to-plasma ratio increased whereas the abscess-to-muscle ratio decreased. DFO enhanced the abscess-to-muscle and abscess-to-plasma ratios by increasing urinary Ga-67 excretion. The authors conclude that abscess imaging with Ga-67 citrate may be improved by administration of (a) Fe for detection of abscesses masked by blood activity, or (b) DFO for detection of abscesses surrounded by muscle tissue.