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Wood JC. Cardiac complications in thalassemia throughout the lifespan: Victories and challenges. Ann N Y Acad Sci 2023; 1530:64-73. [PMID: 37902424 PMCID: PMC10841366 DOI: 10.1111/nyas.15078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Thalassemias are among the most common hereditary diseases in the world because heterozygosity offers protection against malarial infection. Affected individuals have variable expression of alpha or beta chains that lead to their unbalanced utilization during hemoglobin formation, oxidative stress, and apoptosis of red cell precursors prior to maturation. Some individuals produce sufficient hemoglobin to survive but suffer the vascular stress imposed by chronic anemia and ineffective erythropoiesis. In other patients, mature red cell formation is insufficient, and chronic transfusions are required-suppressing anemia and ineffective erythropoiesis but at the expense of iron overload. The cardiovascular consequences of thalassemia have changed dramatically over the previous five decades because of evolving treatment practices. This review summarizes this evolution, focusing on complications and management pertinent to modern patient cohorts.
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Affiliation(s)
- John C Wood
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California, USA
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Soliman AT, Yassin M, Alyafei F, Alaaraj N, Hamed N, Osman S, Soliman N. Nutritional studies in patients with β-thalassemia major: A short review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023187. [PMID: 37326258 PMCID: PMC10308461 DOI: 10.23750/abm.v94i3.14732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Patients with β-thalassemia major (BTM) had variable prevalence of undernutrition and abnormal body composition. Methods: We performed an electronic search in PubMed, Scopus, Research gate, and Web of Sciences to evaluate the prevalence of nutritional disorders in patients with BTM worldwide in relation to their body composition and possible etiological factors. In addition, we reviewed the published nutritional intervention studies. Results: 22 studies on the prevalence of undernutrition (12 countries) and 23 nutritional intervention studies were analyzed. Undernutrition occurred in a considerable number of patients but varied greatly among different countries (from 5.2% to 70%). The lower middle income (LMI) countries (India, Pakistan, Iran, Egypt) had higher prevalence, while (high -middle and high income (Turkey, Greece, North America, USA, Canada) had lower prevalence. Even in patients with normal BMI, abnormalities of body composition are common with decreased muscle mass, lean-body mass, and bone mineral density. 65% to 75% of them had lower energy intake with low levels of circulating nutrients, minerals (zinc, selenium, and copper), and vitamins (D, E) versus controls. Increased macro and micronutrient requirements decreased absorption and /or increased loss or excretion are etiologic factors. Undernutrition was associated with short stature and lower quality of life (QOL). High prevalence of endocrinopathies, poor transfusion regimen (tissue hypoxia), improper chelation, and lack of maternal education, represented important risk factors in the production of poor growth in weight and stature. CONCLUSIONS Timely detection of undernutrition in patients with BTM and proper nutritional intervention could prevent growth delay and comorbidities.
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Lidoriki I, Stavrou G, Schizas D, Frountzas M, Fotis L, Kapelouzou A, Kokkota S, Fyntanidou B, Kotzampassi K. Nutritional Status in a Sample of Patients With β-Thalassemia Major. Cureus 2022; 14:e27985. [PMID: 36120275 PMCID: PMC9468758 DOI: 10.7759/cureus.27985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 01/19/2023] Open
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Sriwichaiin S, Thiennimitr P, Thonusin C, Sarichai P, Buddhasiri S, Kumfu S, Nawara W, Kittichotirat W, Fucharoen S, Chattipakorn N, Chattipakorn SC. Deferiprone has less benefits on gut microbiota and metabolites in high iron-diet induced iron overload thalassemic mice than in iron overload wild-type mice: A preclinical study. Life Sci 2022; 307:120871. [PMID: 35952729 DOI: 10.1016/j.lfs.2022.120871] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/29/2022]
Abstract
AIMS This study aimed to investigate the changes in gut microbiota in iron-overload thalassemia and the roles of an iron chelator on gut dysbiosis/inflammation, and metabolites, including short-chain fatty acids (SCFAs) and trimethylamine N-oxide (TMAO). MAIN METHODS Adult male C57BL/6 mice both wild-type (WT: n = 15) and heterozygous β-thalassemia (BKO: n = 15) were fed on either a normal (ND: n = 5/group) or a high‑iron diet for four months (HFe: n = 10/group). HFe-treated WT and HFe-treated BKO groups were further subdivided into two subgroups and each subgroup given either vehicle (n = 5/subgroup) or deferiprone (n = 5/subgroup) during the last month. Gut microbiota profiles, gut barrier characteristics, levels of proinflammatory cytokines, and plasma SCFAs and TMAO were determined at the end of the study. KEY FINDINGS HFe-fed WT mice showed distinct gut microbiota profiles from those of ND-fed WT mice, whereas HFe-fed BKO mice showed slightly different gut microbiota profiles from ND-fed BKO. Gut inflammation and barrier disruption were found only in HFe-fed BKO mice, however, an increase in plasma TMAO levels and decreased levels of SCFAs were observed in both WT and BKO mice with HFe-feeding. Treatment with deferiprone, gut dysbiosis and disturbance of metabolites were attenuated in HFe-fed WT mice, but not in HFe-fed BKO mice. Increased Verrucomicrobia and Ruminococcaceae were associated with the beneficial effects of deferiprone. SIGNIFICANCE Iron-overload leads to gut dysbiosis/inflammation and disturbance of metabolites, and deferiprone alleviates those conditions more effectively in WT than in those that are thalassemic.
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Affiliation(s)
- Sirawit Sriwichaiin
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand; Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Parameth Thiennimitr
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand; Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Chanisa Thonusin
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand; Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Phinitphong Sarichai
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Songphon Buddhasiri
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; Department of Veterinary Bioscience and Veterinary Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Sirinart Kumfu
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand; Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wichwara Nawara
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand; Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Weerayuth Kittichotirat
- Bioinformatics and Systems Biology Program, School of Bioresources and Technology and School of Information Technology, King Mongkut's University of Technology Thonburi, Bangkok 10150, Thailand; Systems Biology and Bioinformatics Research Group, Pilot Plant Development and Training Institute, King Mongkut's University of Technology Thonburi, Bangkok 10150, Thailand
| | - Suthat Fucharoen
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Nipon Chattipakorn
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand; Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Siriporn C Chattipakorn
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand; Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand.
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El Sehmawy AA, Hassan DA, Elamir RY, Eldesoky NAR, Al Anany MGED, El-Fattah DAA, El Attar S, Abdelbadea A. Assessment of coagulation markers, serum zinc and copper in children with beta-thalassemia major in Egypt. J Trop Pediatr 2022; 68:6709338. [PMID: 36130309 DOI: 10.1093/tropej/fmac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Thalassemia is one of the commonest single gene disorders usually associated with many complications. Coagulation changes as well as trace elements levels alterations have been described in children with β thalassemia. Activation of coagulation can be assessed by measuring thrombin-antithrombin (TAT) complex, plasmin-antiplasmin (PAP) complex and β-thromboglobulin (β-TG). METHODS A total of 200 children and adolescents were enrolled in the study; 100 were from the Al-Azhar University hospital's pediatric hematology clinic diagnosed as thalassemia major, while the other 100 were apparently healthy volunteers who acted as the control group. Complete blood count, liver function test, kidney function tests, TAT complex, PAP complex, β-TG as indicators of coagulation changes, serum zinc and copper were performed on all participants. RESULTS Significantly higher levels of TAT complex, PAP complex and β-TG in thalassemia children than the controls. Decreased serum zinc and increased serum copper levels in thalassemia children compared to the controls. A negative correlation was observed between the serum level of TAT and hemoglobin level, besides the negative correlation of TAT complex and β-TG with the serum zinc. CONCLUSION Thalassemia major was associated with increased serum level of coagulation activation markers, increased serum copper while decreased serum zinc.
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Affiliation(s)
- Asmaa A El Sehmawy
- Pediatrics Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Donia Ahmed Hassan
- Clinical Pathology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Reham Yousri Elamir
- Public Health and Community Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | | | - Shahinaz El Attar
- Biochemistry Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Alzahra Abdelbadea
- Biochemistry Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Talibova G, Ozturk Z, Parlak M, Kupesiz A. Elevated Selenoprotein P Levels in Thalassemia Major Patients. Arch Med Res 2022; 53:508-515. [PMID: 35840466 DOI: 10.1016/j.arcmed.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/17/2022] [Accepted: 07/01/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Previous studies have measured selenium levels and glutathione peroxidase 3 (GPX3) activity in patients with thalassemia major (TM). However, Selenoprotein P (SEPP), which is responsible for the storage and transport of selenium, has not been studied in thalassemia patients. This study aims to correlate thyroid functions of TM patients with their SEPP and GPX3 levels. MATERIALS AND METHODS Eighty subjects (40 controls, 40 TM patients) were included in this study. GPX3 and SEPP concentrations were measured in all subjects using sandwich ELISA. Iron, ferritin, urinary iodine, thyroxine (T4), triiodothyronine (T3), thyrotropin (TSH), anti-thyroid peroxidase (anti-TPO), and anti-human thyroglobulin (anti-hTG) concentrations were also measured. RESULTS Mean SEPP concentration was higher in the TM group compared to the control group. A slight elevation in GPX3 levels was also observed in thalassemia patients, yet it was not statistically significant. In both TM patients and controls, ferritin was inversely correlated with free T4 concentration and GPX3 was inversely correlated with free T4 and T3 concentrations. There was also a negative correlation between SEPP and TSH concentrations in healthy subjects. CONCLUSION This is the first study, which has measured SEPP concentrations in thalassemia patients. SEPP levels were higher in TM patients compared to controls. Correlations between thyroid hormones and selenoproteins may indicate that selenium is necessary for thyroid function. Detailed studies are required to elaborate the role of SEPP in thyroid metabolism in thalassemia patients.
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Affiliation(s)
- Gunel Talibova
- Department of Pediatric Hematology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Zeynep Ozturk
- Department of Pediatric Hematology, Faculty of Medicine, Akdeniz University, Antalya, Turkey; Department of Medical Biochemistry, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mesut Parlak
- Department of Pediatric Endocrinology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Alphan Kupesiz
- Department of Pediatric Hematology, Faculty of Medicine, Akdeniz University, Antalya, Turkey.
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Zinc, Magnesium, and Copper Levels in Patients with Sickle Cell Disease: A Systematic Review and Meta-analysis. Avicenna J Med 2022; 12:45-53. [PMID: 35833156 PMCID: PMC9272455 DOI: 10.1055/s-0042-1749612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background
Sickle cell disease (SCD) is associated with oxidative stress due to an imbalance between production and elimination of the reactive oxygen species. It has been reported that SCD patients are at risk of multiple micronutrients' deficiencies, including several trace elements involved in the antioxidation mechanisms. We aimed to assess the status of these micronutrients in SCD patients.
Methods
This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The databases of MedLine, Embase, and PsycInfo were used for the systematic search from time the databases existed until April 2021. A total of 36 studies fulfilled the eligibility criteria. We calculated the pooled standardized mean difference (SMD) of serum zinc, magnesium, or copper levels among patients with SCD and their healthy controls.
Results
SCD patients had significantly lower zinc (SMD = −1.27 [95% CI: 1.67−0.87,
p
0.001]) and magnesium levels (SMD = −0.53 [95% CI: 1.0−0.06,
p
0.026] than their controls. Copper level was found to be significantly higher in SCD patients, with SMD = 0.68 (95% CI: 0.05−1.32,
p
0.004).
Conclusion
This review showed that SCD patients may potentially prompt to have lower zinc and magnesium levels and higher copper levels compared with those without the disease. Future research need to be directed to investigate clinical outcome of nutritional difficiencies in patients with SCD, as well as the possibility of implementing nutritional supplement programs which may help minimizing the harmful effects of the disease on human body.
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Goldberg EK, Lal A, Fung EB. Nutrition in Thalassemia: A Systematic Review of Deficiency, Relations to Morbidity, and Supplementation Recommendations. J Pediatr Hematol Oncol 2022; 44:1-11. [PMID: 34486568 PMCID: PMC8732300 DOI: 10.1097/mph.0000000000002291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/24/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Reports of nutritional deficiencies in patients with thalassemia (Thal) are common. Despite its importance, however, nutritionally focused research in Thal has been limited by inadequate sample size, inconsistent methodology, a lack of control comparisons, and few interventional trials. Due to these limitations, clinicians lack evidence-based nutrition recommendations to support clinical decision-making. This systematic review summarizes observed relationships between nutrition and morbidity in Thal published in the last 3 decades. METHODS PubMed, Web of Science, and Embase were screened for articles pertaining to nutrition in Thal using comprehensive search terms. Studies performed in humans, written in English, and published between 1990 and 2020 were included. Over 2100 manuscripts were identified, from which 97 were included. RESULTS Patients with Thal were most often deficient in vitamins A, C, D, selenium, and zinc. Prevalence of nutritional deficiency was positively correlated with age and iron overload. Evidence to support the role of vitamin D and zinc for bone health was observed; zinc was also found to improve glucose metabolism. CONCLUSIONS Due to the risk for multinutrient deficiency, nutritional status should be assessed annually in patients with Thal with prompt nutrient replacement when deficiency is detected. Routine supplementation with vitamin D and zinc is recommended.
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Affiliation(s)
| | - Ashutosh Lal
- Division of Hematology, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Ellen B Fung
- Children's Hospital Oakland Research Institute (CHORI)
- Division of Hematology, UCSF Benioff Children's Hospital Oakland, Oakland, CA
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Mousa SO, Abd Alsamia EM, Moness HM, Mohamed OG. The effect of zinc deficiency and iron overload on endocrine and exocrine pancreatic function in children with transfusion-dependent thalassemia: a cross-sectional study. BMC Pediatr 2021; 21:468. [PMID: 34686155 PMCID: PMC8532363 DOI: 10.1186/s12887-021-02940-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/12/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Children with transfusion-dependent thalassemia (TDT) suffer from secondary hemosiderosis and the delirious effects this iron overload has on their different body organs, including the pancreas. They are also more prone to develop zinc deficiency than the general pediatric population. This study aimed to determine the effect of zinc deficiency and iron overload on the endocrine and exocrine pancreas in TDT children. METHODS Eighty children, already diagnosed with TDT, were included in this study. We assessed the following in the participant children: serum ferritin, serum zinc, endocrine pancreatic function (oral glucose tolerance test (OGTT), fasting insulin level and from them, HOMA-IR was calculated), and exocrine pancreatic function (serum lipase and serum amylase). RESULTS Forty-four TDT children had a subnormal zinc level, while 36 of them had a normal serum zinc level. TDT children with low serum zinc had significantly more impaired endocrine pancreatic function and an abnormally high serum lipase than children with normal serum zinc, p < 0.05 in all. Serum zinc was significantly lower in TDT children with serum ferritin above the ferritin threshold (≥2500 ng/ml) than those below (59.1 ± 20.2 vs. 77.5 ± 28.13), p = 0.02. TDT children, having a serum ferritin ≥2500 ng/ml, had significantly more frequently impaired endocrine pancreatic function and abnormally high serum lipase than TDT children below the ferritin threshold, p < 0.05 in all. CONCLUSION In children with transfusion-dependent thalassemia, zinc deficiency aggravates iron-induced pancreatic exocrine and endocrine dysfunction.
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Affiliation(s)
- Suzan O. Mousa
- Pediatric Department, Children’s University hospital, Faculty of Medicine, Minia University, El-Minya, Egypt
| | - Ebtihal M. Abd Alsamia
- Pediatric Department, Children’s University hospital, Faculty of Medicine, Minia University, El-Minya, Egypt
| | - Hend M. Moness
- Department of Clinical Pathology, Minia University hospitals, Minia University, El-Minya, Egypt
| | - Osama G. Mohamed
- Pediatric Department, Children’s University hospital, Faculty of Medicine, Minia University, El-Minya, Egypt
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Alhillawi ZH, Al-Hakeim HK, Moustafa SR, Maes M. Increased zinc and albumin but lowered copper in children with transfusion-dependent thalassemia. J Trace Elem Med Biol 2021; 65:126713. [PMID: 33453474 DOI: 10.1016/j.jtemb.2021.126713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 12/11/2020] [Accepted: 01/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Measurements of copper and zinc in transfusion-dependent thalassemia (TDT) show contradictory results. AIM OF THE STUDY To examine serum levels of these minerals in TDT in relation to iron overload indices and erythron variables. METHODS This study recruited 60 children with TDT and 30 healthy controls aged 3-12 years old. RESULTS Zinc was significantly higher in TDT children than in controls, while copper and the copper to zinc ratio were significantly lowered in TDT. Serum zinc was significantly associated with the number of blood transfusions and iron overload variables (including serum iron and TS%) and negatively with erythron variables (including hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin). Serum copper was significantly and negatively associated with the same iron overload and erythron variables. The copper to zinc ratio was significantly correlated with iron, TS%, ferritin, hemoglobin, mean corpuscular volume, and mean corpuscular hemoglobin. Albumin levels were significantly higher in TDT children than in control children. CONCLUSION Our results suggest that the increase in zinc in children with TDT may be explained by iron loading anemia and hemolysis and the consequent shedding of high amounts of intracellular zinc into the plasma. Increased albumin levels and treatment with Desferral may further contribute towards higher zinc levels in TDT. We suggest that the elevations in zinc in TDT are a compensatory mechanism protecting against infection, inflammation, and oxidative stress. Previous proposals for prophylactic use of zinc supplements in TDT may not be warranted.
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Affiliation(s)
| | | | - Shatha Rouf Moustafa
- Clinical Analysis Department, College of Pharmacy, Hawler Medical University, Havalan City, Erbil, Iraq.
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria; IMPACT Strategic Research Centre, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.
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Allen A, Perera S, Mettananda S, Rodrigo R, Perera L, Darshana T, Moggach F, Jackson Crawford A, Heirene L, Fisher C, Olivieri N, Rees D, Premawardhena A, Allen S. Oxidative status in the β-thalassemia syndromes in Sri Lanka; a cross-sectional survey. Free Radic Biol Med 2021; 166:337-347. [PMID: 33677065 DOI: 10.1016/j.freeradbiomed.2021.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/17/2021] [Accepted: 02/21/2021] [Indexed: 01/10/2023]
Abstract
In the β-thalassemias, oxidative stress, resulting from chronic hemolysis, globin chain imbalance, iron overload and depleted antioxidant defences, likely contributes to cell death, organ damage, anemia, hypoxia and inflammation. We assessed variations in these parameters in β-thalassemia syndromes in Sri Lanka. Between November 2017 and June 2018, we assessed children and adults attending two thalassemia centres in Sri Lanka: 59 patients with HbE β-thalassemia, 50 β-thalassemia major, 40 β-thalassemia intermedia and 13 HbS β-thalassemia. Median age was 26.0 years (IQR 15.3-38.8), 101 (62.3%) were female and 152 (93.8%) of Sinhalese ethnicity. Methemoglobin, plasma hemoglobin, heme and ferritin were measured as sources of oxidants; plasma total antioxidant capacity, haptoglobin, hemopexin and vitamins C and E assessed antioxidant status; plasma thiobarbituric acid reactive substances and 8-hydroxy-2'-deoxyguanosine assessed oxidative damage; hemoglobin, plasma erythropoietin and transferrin receptor assessed anemia and hypoxia and plasma interleukin-6 and C-reactive protein assessed inflammation. Fruit and vegetable intake was determined by dietary recall. Physical fitness was investigated using the 6-min walk test and measurement of handgrip strength. Oxidant sources were frequently increased and antioxidants depleted, with consequent oxidative damage, anemia, hypoxia and inflammation. Biomarkers were generally most abnormal in HbE β-thalassemia and least abnormal in β-thalassemia intermedia but also varied markedly between individuals with the same thalassemia syndrome. Oxidative stress and damage were also more severe in splenectomized patients and/or those receiving iron chelation therapy. Less than 15% of patients ate fresh fruits or raw vegetables frequently, and plasma vitamins C and E were deficient in 132/160 (82.5%) and 140/160 (87.5%) patients respectively. Overall, physical fitness was poor in all syndromes and was likely due to anemic hypoxia. Studies of antioxidant supplements to improve outcomes in patients with thalassemia should consider individual patient variation in oxidative status both between and within the thalassemia syndromes.
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Affiliation(s)
- Angela Allen
- Department of Molecular Haematology, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Headington, Oxford, UK; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK.
| | - Shiromi Perera
- Department of Biochemistry and Clinical Chemistry, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | - Sachith Mettananda
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | - Rexan Rodrigo
- Thalassemia Care Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - Lakshman Perera
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | - Thamal Darshana
- Department of Medical Laboratory Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Fiona Moggach
- Department of Clinical Biochemistry, Macewen Building, Glasgow Royal Infirmary, Castle Street, Glasgow, UK
| | - Anthony Jackson Crawford
- Department of Clinical Chemistry, Aneurin Bevan University Health Board, Grange University Hospital, Llanyravon, Cwmbran, Gwent, UK
| | - Lesley Heirene
- Department of Clinical Chemistry, Aneurin Bevan University Health Board, Grange University Hospital, Llanyravon, Cwmbran, Gwent, UK
| | - Christopher Fisher
- Department of Molecular Haematology, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Headington, Oxford, UK
| | - Nancy Olivieri
- Professor of Pediatrics, Medicine and Public Health Sciences, University of Toronto, Toronto, Canada
| | - David Rees
- Department of Paediatric Haematology, King's College Hospital, London, UK
| | - Anuja Premawardhena
- Thalassemia Care Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka; Department of Medicine, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | - Stephen Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
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Zardkhoni SZ, Moghaddam AG, Rad F, Ghatee MA, Omidifar N, Ghaedi M, Etemadfar P. Serum Zinc Level in β-Thalassemia Major: A Retrospective Study in Southwest Iran. Hemoglobin 2021; 45:103-106. [PMID: 33896336 DOI: 10.1080/03630269.2021.1918149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Thalassemia, which is associated with compound complications, is the most common hereditary anemia in the world. The zinc level is different in patients with thalassemias. This study aimed to determine the zinc status and its relationship with demographic factors and chelation therapy in β-thalassemia major (β-TM) patients. This cross-sectional study was conducted on 102 β-thalassemia (β-thal), patients. Zinc level was evaluated in subjects using the atomic absorption method. The results were analyzed through descriptive statistics, χ2 and Mann-Whitney U tests. Of 102 cases, 92 patients were eligible and evaluated. The mean age was 23 (minimum 11, maximum 43) years. Forty-six percent of cases were males and 54.0% were females. Of the 92 patients taking iron chelators, 29.3% used deferoxamine (DFO), 16.3% deferasirox (DFX), 20.6% DFO and deferiprone (DFP), and 33.8% DFO and DFP. All cases had zinc deficiency, 89.1% had zinc levels <40.0 mg/dL, and 10.9% with zinc levels >40.0 mg/dL. There was a significant relationship between gender and group with zinc levels greater than 40.0 mg/dL and those with less than 40.0 mg/dL. Zinc deficiency is highly prevalent among patients with thalassemia in the city of Yasuj, Iran. There was a significant relationship between zinc levels and gender although no significance was observed between zinc level and age, body mass index (BMI), ferritin, and chelation factors; it is recommended that these patients be periodically evaluated for zinc level. In case of a lack of laboratory evaluation, the use of prophylactic zinc supplementation should be considered for these patients.
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Affiliation(s)
| | - Abdolkarim G Moghaddam
- Department of Pediatrics, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Fariba Rad
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mohammad A Ghatee
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.,Department of Medical Parasitology and Mycology, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Navid Omidifar
- Department of Medical Pathology, Faculty of Anatomical and Clinical Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrorang Ghaedi
- Department of Chemistry, Faculty of Yasuj University, Yasuj, Iran
| | - Peyman Etemadfar
- Department of Pediatrics, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran.,Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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13
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The effect of curcumin on serum copper, zinc, and zinc/copper ratio in patients with β-thalassemia intermedia: a randomized double-blind clinical trial. Ann Hematol 2021; 100:627-633. [PMID: 33432439 DOI: 10.1007/s00277-021-04397-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/03/2021] [Indexed: 10/22/2022]
Abstract
Thalassemia intermedia is a subgroup of β-thalassemia which originates from mutations in the beta-globin gene. Zinc and copper play important roles in the metabolism. Due to its significant therapeutic effects, curcumin has led many studies to focus on curcumin. In a double-blind clinical trial study, 30 patients with beta-thalassemia intermedia with an age range of 20 to 35 years were randomly selected 1:1 to receive either curcumin or placebo for 3 months. Before and after the intervention period, 5 ml of blood was taken to determine the serum levels of zinc and copper. The laboratory tests were checked at baseline and at the end of the treatment. While the serum levels of zinc and zinc/copper significantly increased, the serum levels of copper decreased after 3 months of curcumin intake. In addition, on the basis of baseline characteristics, a negative correlation was found between zinc and body mass index and positive correlations were identified between copper with triglyceride and high-density lipoprotein. Also, the level of ferritin protein in the curcumin group compared to the placebo group showed a significant decrease after 3 months of curcumin use. Therefore, it could be concluded that curcumin might exert a net protective effect on copper toxicity in thalassemia intermedia patients. The investigation also implicated that curcumin represents an approach to regulating zinc homeostasis and may be useful as a complementary treatment of patients with thalassemia intermedia, especially in patients with zinc deficiency or low serum zinc/copper ratio. Clinical Trial Registration Number: IRCT20190902044668N1.
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14
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Delesderrier E, Curioni C, Omena J, Macedo CR, Cople-Rodrigues C, Citelli M. Antioxidant nutrients and hemolysis in sickle cell disease. Clin Chim Acta 2020; 510:381-390. [PMID: 32673671 DOI: 10.1016/j.cca.2020.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 01/29/2023]
Abstract
Hemolysis is one of the main pathophysiological characteristics of sickle cell disease (SCD) and might cause or could be the result of oxidative stress. Antioxidants are studied in SCD due to their potential to ensure redox balance and minimize deleterious effects on erythrocyte membranes. The objective of this systematic review was to evaluate the efficacy of antioxidant nutrient supplementation on reducing hemolysis in SCD patients through randomized clinical trials. We conducted our study according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses and the Cochrane Handbook for Systematic Reviews of Interventions investigating whether antioxidants could improve the hemolytic status of SCD patients. This study included 587 articles published until April 2020. We reduced this pool to 12 articles by excluding duplicates, reviews, comments, and studies with non-human subjects. Omega-3 fatty acids, vitamin A, and zinc were the antioxidants that reportedly improved the indirect hemolysis parameters such as hemoglobin, hematocrit, mean corpuscular volume, or red blood cells. High-dose vitamin C and E supplementation worsened hemolysis, causing increased reticulocytes, lactate dehydrogenase, indirect bilirubin, and haptoglobin. More intervention studies especially high-quality controlled randomized clinical trials are needed to investigate the effects of antioxidant nutrients in reducing hemolysis in SCD.
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Affiliation(s)
- Emília Delesderrier
- Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Cíntia Curioni
- Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Juliana Omena
- Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | | | - Marta Citelli
- Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil.
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15
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Body Composition in Egyptian Children With Transfusion-dependent Thalassemia: The Impact of Nutrition and Metabolic Profile. J Pediatr Hematol Oncol 2020; 42:e334-e339. [PMID: 31929387 DOI: 10.1097/mph.0000000000001712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Growth failure is a common complication in children with beta-thalassemia major (β-TM) that has persisted despite major treatment advances. It could stem from malnutrition, especially in those who live in poor countries and who have inadequate nutrient intake. AIM The aim of this study was to assess the influence of nutrition on growth, total body composition, and metabolic profile in Egyptian children with β-TM. SUBJECTS AND METHODS This cross-sectional study included 200 children with β-TM and 50 age-matched and sex-matched healthy children. All subjects underwent full clinical assessment, which included assessment of growth and total body composition using anthropometric measurements (weight, height, mid-arm circumference, skinfold thickness, and body mass index) and bioelectric impedance analysis device (TANITA SC330). Nutritional assessment was performed using 24-hour dietary recall. Fasting serum insulin, C-peptide, and fasting serum lipid profile (high-density lipoprotein, low-density lipoprotein, cholesterol, and triglyceride) were measured. RESULTS Children with β-TM had a significantly lower mean value of the daily consumption of the studied nutrient elements including kilocalories, protein, carbohydrate, calcium, and phosphorus (P<0.001). β-TM had a negative impact on anthropometric measures; the mean of all measurements recorded in children with β-TM was significantly lower than that in the control group (P<0.001). Children with β-TM had a significant abnormality in lipid profile, with higher triglyceride levels and lower cholesterol, low-density lipoprotein, and high-density lipoprotein than controls. They had significantly lower serum insulin and C-peptide. Age, sex, serum ferritin, and caloric intake have a significant impact on body composition in children with β-TM. CONCLUSION Regular assessment of nutrition is crucial for the health of children with β-TM.
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16
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Samarron SL, Miller JW, Cheung AT, Chen PC, Lin X, Zwerdling T, Wun T, Green R. Homocysteine is associated with severity of microvasculopathy in sickle cell disease patients. Br J Haematol 2020; 190:450-457. [PMID: 32307711 DOI: 10.1111/bjh.16618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 12/31/2022]
Abstract
The pathophysiology of sickle cell disease (SCD) includes vasculopathy as well as anaemia. Elevated plasma homocysteine is a risk factor for vascular disease and may be associated with increased risk of vascular complications in SCD patients. In the present study, microvascular characteristics were assessed in the bulbar conjunctiva of 18 paediatric and 18 adult SCD patients, using the non-invasive technique of computer-assisted intravital microscopy. A vasculopathy severity index (SI) was computed to quantify the degree of microvasculopathy in each patient. Plasma homocysteine and several of its determinants [serum folate and vitamin B12, plasma pyridoxal-5'-phosphate (vitamin B6 status) and creatinine (kidney function)] were measured. Age was strongly correlated with microvasculopathy in the SCD patients, with the SI increasing about 0·1 unit per one-year increase in age (P < 0·001). After adjusting for age, gender, B-vitamin status and creatinine, homocysteine concentration was directly correlated with severity index (P < 0·05). Age and homocysteine concentration were independent predictors of microvasculopathy in SCD patients. It remains to be determined whether lowering homocysteine concentrations using appropriate B-vitamin supplements (folate and vitamins B12 and B6) - particularly if started early in life - could ameliorate microvasculopathy and its associated complications in SCD patients.
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Affiliation(s)
- Sandra L Samarron
- Department of Medical Pathology and Laboratory Medicine, University of California, Davis, CA, USA
| | - Joshua W Miller
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ, USA
| | - Anthony T Cheung
- Department of Medical Pathology and Laboratory Medicine, University of California, Davis, CA, USA.,Institute for Biomedical Sciences, San Diego, CA, USA
| | - Peter C Chen
- Institute for Biomedical Sciences, San Diego, CA, USA.,Shiley Center for Orthopaedic Research and Education, La Jolla, CA, USA
| | - Xin Lin
- Department of Medical Pathology and Laboratory Medicine, University of California, Davis, CA, USA
| | - Theodore Zwerdling
- Department of Pediatrics (Hematology-Oncology), University of California, Davis, CA, USA
| | - Ted Wun
- Department of Medical Pathology and Laboratory Medicine, University of California, Davis, CA, USA.,Department of Internal Medicine (Hematology-Oncology), University of California, Davis, CA, USA.,UC Davis Clinical and Translational Science Center, Sacramento, CA, USA
| | - Ralph Green
- Department of Medical Pathology and Laboratory Medicine, University of California, Davis, CA, USA.,Department of Internal Medicine (Hematology-Oncology), University of California, Davis, CA, USA
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17
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Aboutalebi A, Jouyban A, Chavoshi H, Movassaghpour Akbari A, Shaseb E, Sarbakhsh P, Ghaffary S. Protective Effects of Selenium in Patients with Beta-Thalassemia Major. PHARMACEUTICAL SCIENCES 2020. [DOI: 10.34172/ps.2019.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background
: Beta-thalassemia major patients require repeated blood transfusion which is associated with iron overload in different organs such as heart, liver, kidney and their related complications. In this study the effects of selenium in iron overload related complications of patients with beta-thalassemia major were assessed. Methods: In this clinical trial, 34 beta-thalassemia major patients over 12 years old were enrolled. Patients with severe renal failure, history of selenium consumption over the last three months, change of blood transfusion pattern, and any change of chelating agent were excluded from the study. For all patients, tablet of selenium 200 µg/day was administered for a month. Blood samples were taken at baseline and after one-month to assess the level of ferritin, total iron-binding capacity (TIBC), aspartate aminotransferase (AST), alanine aminotransferase (ALT), serum creatinine (Scr), selenium. Hair loss was assessed by questionnaire before and after intervention. Results: From 34 patients, 27 (79.4%) had deficient level of selenium at baseline. The selenium level was increased after intervention (p=0.005). The level of serum ALT and Scr decreased remarkably after one-month selenium consumption (p=0.007 for both). In addition, the AST level decreased remarkably after intervention (p=0.053). Severe hair loss profile has improved significantly after supplementation (p=0.004). Conclusion: One-month selenium consumption improved liver and kidney function related markers remarkably. Moreover, selenium improved hair profile and severe hair loss in thalassemia patients. Further studies are needed on the effect of selenium administration on liver and kidney function.
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Affiliation(s)
- Ajand Aboutalebi
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abolghasem Jouyban
- Pharmaceutical Analysis Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Chavoshi
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Elnaz Shaseb
- Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parvin Sarbakhsh
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saba Ghaffary
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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18
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Coates TD. Iron overload in transfusion-dependent patients. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:337-344. [PMID: 31808901 PMCID: PMC6913424 DOI: 10.1182/hematology.2019000036] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Before the advent of effective iron chelation, death from iron-induced cardiomyopathy occurred in the second decade in patients with transfusion-dependent chronic anemias. The advances in our understanding of iron metabolism; the ability to monitor iron loading in the liver, heart, pancreas and pituitary; and the availability of several effective iron chelators have dramatically improved survival and reduced morbidity from transfusion-related iron overload. Nevertheless, significantly increased survival brings about new complications such as malignant transformation resulting from prolonged exposure to iron, which need to be considered when developing long-term therapeutic strategies. This review discusses the current biology of iron homeostasis and its close relation to marrow activity in patients with transfusion-dependent anemias, and how biology informs clinical approach to treatment.
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Affiliation(s)
- Thomas D Coates
- Hematology Section, Children's Center for Cancer, Blood Diseases and Bone Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
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19
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Salama N, Fahmy R, Youness ER. Cognitive functions and anti-oxidant in children with sickle cell disease: A single center based study. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2019. [DOI: 10.1186/s43054-019-0005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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20
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Azzam M, Attalla S. Serum Folate Levels in Patients with Chronic Hemolytic Anemia on Regular Folic Acid Supplementation Before and After Dose Modification. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1611-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Selenium Status and Hemolysis in Sickle Cell Disease Patients. Nutrients 2019; 11:nu11092211. [PMID: 31540239 PMCID: PMC6770466 DOI: 10.3390/nu11092211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 12/31/2022] Open
Abstract
Sickle cell disease (SCD) is a genetic hemoglobinopathy characterized by chronic hemolysis. Chronic hemolysis is promoted by increased oxidative stress. Our hypothesis was that some antioxidant micronutrients (retinol, tocopherol, selenium, and zinc) would be determinant factors of the degree of hemolysis in SCD patients. We aimed to investigate the nutritional adequacy of these antioxidants and their relationships to hemolysis. The study included 51 adult SCD patients regularly assisted in two reference centers for hematology in the State of Rio de Janeiro, Brazil. Serum concentrations of retinol, alpha-tocopherol, selenium, and zinc were determined by high-performance liquid chromatography or atomic absorption spectrometry. Hematological parameters (complete blood count, reticulocyte count, hemoglobin, direct and indirect bilirubin, total bilirubin, lactate dehydrogenase) and inflammation markers (leukocytes and ultra-sensitive C-reactive protein) were analyzed. A linear regression model was used to test the associations between the variables. Most patients presented selenium deficiency and low selenium consumption. Linear regression analysis showed that selenium is the main determinant of hemolysis among the antioxidant nutrients analyzed. Thus, data from this study suggest that the nutritional care protocols for patients with SCD should include dietary sources of selenium in order to reduce the risk of hemolysis.
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22
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Baptista LC, Figueira CO, Souza BB, Fertrin KY, Antolini A, Costa FF, de Melo MB, Costa ML. Different morphological and gene expression profile in placentas of the same sickle cell anemia patient in pregnancies of opposite outcomes. Exp Biol Med (Maywood) 2019; 244:395-403. [PMID: 30818999 DOI: 10.1177/1535370219834305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IMPACT STATEMENT Environmentally induced changes in placental morphological and molecular phenotypes may provide relevant insight towards pathophysiology of diseases. The rare opportunity to evaluate the same patient, with sickle cell anemia (SCA), in two different pregnancies, of opposite outcomes (one early onset severe preeclampsia (PE) and the other mostly non-complicated) can prove such concept. In addition, the comparison to other conditions of known placental and vascular/inflammatory involvement strengthens such findings. Our results suggest that the clinical association between SCA and PE can be supported by common pathophysiological mechanisms, but that pathways involving response to copper and triglyceride metabolism may be important drivers of the pathophysiology of PE. Future studies using in a larger number of samples should confirm these findings and explore pathways involved in the pathophysiology of PE and its relationship with SCA.
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Affiliation(s)
- Letícia C Baptista
- 1 Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas - UNICAMP, Campinas, SP 13083-875, Brazil.,*Shared first and last authorship
| | - Camilla O Figueira
- 2 Department of Obstetrics and Gynecology, University of Campinas - UNICAMP, Campinas, SP 13083-880, Brazil.,*Shared first and last authorship
| | - Bruno B Souza
- 1 Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas - UNICAMP, Campinas, SP 13083-875, Brazil
| | - Kleber Y Fertrin
- 3 Division of Hematology, University of Washington, Seattle, WA 98195-7230, USA
| | - Arthur Antolini
- 4 Department of Pathology, University of Campinas - UNICAMP, Campinas, SP 13083-887, Brazil
| | - Fernando F Costa
- 5 Hematology and Hemotherapy Center, University of Campinas - UNICAMP, Campinas, SP 13083-878
| | - Mônica B de Melo
- 1 Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas - UNICAMP, Campinas, SP 13083-875, Brazil.,*Shared first and last authorship
| | - Maria Laura Costa
- 2 Department of Obstetrics and Gynecology, University of Campinas - UNICAMP, Campinas, SP 13083-880, Brazil.,*Shared first and last authorship
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23
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Nutritional Deficiencies Are Common in Patients with Transfusion-Dependent Thalassemia and Associated with Iron Overload. ACTA ACUST UNITED AC 2018; 6:674-681. [PMID: 30569002 DOI: 10.12691/jfnr-6-10-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Patients with thalassemia are frequently deficient in key micronutrients. Attempts to correct these inadequacies through nutritional supplementation have been met with some success, although disparities between intake and circulating levels continue to be observed. This study employed a convenience sample of 41 well-nourished transfusion dependent patients with thalassemia to identify possible mechanisms behind nutritional deficiencies. Each subject completed a Block 2005© Food Frequency Questionnaire (FFQ), through which macro and micronutrient intake was quantified. Fasting blood was drawn to assess vitamins A, C, D, E, copper, selenium, zinc and hematologic parameters. Dietary intake was found to be inadequate compared to Institute of Medicine (IOM) recommendations for many of the fat-soluble vitamins, as well as calcium and zinc. Circulating deficiencies of vitamins C, D, copper, zinc and γ tocopherol were also present in over 20% of patients. Many individuals who consumed an adequate dietary intake had deficient levels of circulating nutrients, which suggest alternative etiologies of nutrient excretion or loss, in addition to higher micronutrient requirements. Liver iron concentration displayed a significant negative relationship with vitamins C (r=-0.62, p<0.001), E (r=-0.37, p=0.03), and zinc (r=-0.35, p=0.037), indicating that in iron-overloaded patients, these nutrients are either endogenously consumed at higher rates or sequestered within the liver, resulting in a functional nutrient deficiency. While this study identified hepatic iron overload to be a significant cause of nutritional deficits commonly observed in patients with thalassemia, multiple etiologies are simultaneously responsible. In response to these findings, nutritional status should be monitored regularly in at-risk patients with thalassemia, and prophylactically addressed with supplementation or aggressive chelation to avoid associated co-morbidities.
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De Sanctis V, Soliman AT, Elsefdy H, Soliman N, Bedair E, Fiscina B, Kattamis C. Bone disease in β thalassemia patients: past, present and future perspectives. Metabolism 2018; 80:66-79. [PMID: 28987275 DOI: 10.1016/j.metabol.2017.09.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/07/2017] [Accepted: 09/10/2017] [Indexed: 01/23/2023]
Abstract
Bone disorders in patients with thalassemia major (TM) and intermedia (TI) constitute complex conditions that result from various factors affecting the growing skeleton. Although much progress has been made in our understanding of the natural history, pathogenesis and clinical manifestations of β- and δβ-thalassemia, bone manifestations remain a puzzle for the clinician. In this review, we outline the key points in the current literature on the pathogenesis and management of bone disease in patients with TM and TI who were conventionally treated in recent decades with frequent blood transfusions and iron chelation. Prevention, early recognition and treatment are the most effective strategies for the management of bone disease in these patients. However, further studies are required to maintain optimal bone health for both TM and TI patients. Studying bone disease in patients with non-transfusion dependent TI, which seems to worsen considerably with age, is important to delineate the effect of the disease itself on bone health without the intervening factors of transfusions, iron intoxication and chelation.
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Affiliation(s)
- Vincenzo De Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy.
| | - Ashraf T Soliman
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar; Department of Pediatrics, Division of Endocrinology, Alexandria University Children's Hospital, Alexandria, Egypt
| | - Heba Elsefdy
- Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Nada Soliman
- Primary Health Care, Ministry of Health, Alexandria, Egypt
| | - Elsaid Bedair
- Department of Radiology, AlKhor Hospital, Hamad Medical Center, Doha, Qatar
| | | | - Christos Kattamis
- First Department of Paediatrics, University of Athens, Athens, Greece
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25
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Farooq S, Mazhar W, Siddiqui AJ, Ansari SH, Musharraf SG. Quantitative assessment of metal dysregulation in β-thalassemia patients in comparison with healthy controls by ICP-MS and chemometric analyses. Biomed Chromatogr 2018; 32:e4200. [PMID: 29388244 DOI: 10.1002/bmc.4200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 12/16/2022]
Abstract
β-Thalassemia is one of the most common inherited disorders and is widely distributed throughout the world. Owing to severe deficiencies in red blood cell production, blood transfusion is required to correct anemia for normal growth and development but causes additional complications owing to iron overload. The aim of this study is to quantify the biometal dysregulations in β-thalassemia patients as compared with healthy controls. A total of 17 elements were analyzed in serum samples of β-thalassemia patients and healthy controls using ICP-MS followed by chemometric analyses. Out of these analyzed elements, 14 showed a significant difference between healthy and disease groups at p < 0.05 and fold change >3. A PLS-DA model revealed an excellent separation with 89.8% sensitivity and 97.2% specificity and the overall accuracy of the model was 92.2%. This metallomic study revealed that there is major difference in metallomic profiling of β-thalassemia patients specifically in Co, Mn, Ni, V and Ba, whereas the fold changes in Co, Mn, V and Ba were found to be greater than that in Fe, providing evidence that, in addition to Fe, other metals are also altered significantly and therefore chelation therapy for other metals may also needed in β-thalassemia patients.
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Affiliation(s)
- Sabiha Farooq
- H.E.J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Wardah Mazhar
- H.E.J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Amna Jabbar Siddiqui
- H.E.J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Saqib Hussain Ansari
- Department of Pediatric Hematology and Molecular Medicine, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Syed Ghulam Musharraf
- H.E.J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan.,Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
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26
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Jagadeeswaran R, Rivers A. Evolving treatment paradigms in sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:440-446. [PMID: 29222291 PMCID: PMC6142561 DOI: 10.1182/asheducation-2017.1.440] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Sickle cell disease (SCD) is an inheritable hemoglobinopathy characterized by polymerization of hemoglobin S in red blood cells resulting in chronic hemolytic anemia, vaso-occlusive painful crisis, and multiorgan damage. In SCD, an increased reactive oxygen species (ROS) generation occurs both inside the red blood cells and inside the vascular lumen, which augment hemolysis and cellular adhesion. This review discusses the evolving body of literature on the role of ROS in the pathophysiology of SCD as well as some emerging therapeutic approaches to SCD with a focus on the reduction of ROS.
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Affiliation(s)
- Ramasamy Jagadeeswaran
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL; and
- Jesse Brown Veterans Affairs Medical Center, Chicago, IL
| | - Angela Rivers
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL; and
- Jesse Brown Veterans Affairs Medical Center, Chicago, IL
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De Sanctis V, Soliman AT, Elsedfy H, Di Maio S, Canatan D, Soliman N, Karimi M, Kattamis C. Gonadal dysfunction in adult male patients with thalassemia major: an update for clinicians caring for thalassemia. Expert Rev Hematol 2017; 10:1095-1106. [PMID: 29072100 DOI: 10.1080/17474086.2017.1398080] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Hypogonadism is the most frequently reported endocrine complication, affecting 40%-80% of thalassemia major (TM) patients. The prevalence and severity of hypogonadism in TM varies among studies, depending on patients' age, genotype, transfusion frequency and starting age and efficiency of iron chelation. Areas covered: The diagnosis requires careful clinical assessment and appropriate laboratory testing. Its management is more complex compared to other 'classical' causes of hypogonadism because of multiple associated disorders (cardiac, hepatic and endocrine) and other contributing factors basically iron overload and iron toxicity. Expert commentary: Early recognition and treatment of hypogonadism in TM patients is most important to prevent late complications and to enhance the chances of parenthood. The goal of management is to restore deficient glandular function. If fertility is the issue and the testis is under-stimulated because of gonadotropin deficiency, it is possible to induce or restore spermatogenesis with exogenous gonadotropins in some patients. Assisted reproductive techniques may supplementary help to overcome previously untreatable causes of male infertility. These positive achievements should encourage health care providers to pay closer attention to the reproductive health of TM patients. This would involve the collaboration of clinicians caring for thalassemia with endocrinologists and specialists in assisted reproductive technologies.
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Affiliation(s)
- Vincenzo De Sanctis
- a Pediatric and Endocrine Outpatient Clinic , Quisisana Hospital , Ferrara , Italy
| | - Ashraf T Soliman
- b Department of Pediatrics, Division of Endocrinology , Alexandria University Children's Hospital , Alexandria , Egypt
| | - Heba Elsedfy
- c Department of Pediatrics , Ain Shams University , Cairo , Egypt
| | - Salvatore Di Maio
- d Emeritus Director in Pediatrics , Santobono-Pausilipon Hospital , Naples , Italy
| | - Duran Canatan
- e Director of Thalassemia Diagnosis Center of Mediterranean Blood Diseases Foundation , Antalya , Turkey
| | - Nada Soliman
- f Student's Hospital , Ministry of Health , Alexandria , Egypt
| | - Mehran Karimi
- g Hematology Research Center , Shiraz University of Medical Science , Shiraz , Iran
| | - Christos Kattamis
- h First Department of Paediatrics , University of Athens , Athens , Greece
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Khurana M, Fung EB, Vichinsky EP, Theil EC. Dietary nonheme iron is equally bioavailable from ferritin or ferrous sulfate in thalassemia intermedia. Pediatr Hematol Oncol 2017; 34:455-467. [PMID: 29232169 DOI: 10.1080/08880018.2017.1395935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
UNLABELLED Transfusion-independent patients with thalassemia intermedia (TI) develop fatal iron overload from excessive iron absorption triggered by ineffective erythropoiesis. More information about iron pharmacokinetics and nonheme, dietary iron absorption in such patients is needed to optimize management. To obtain more information, different forms of supplemental nonheme iron sources (ferritin and ferrous sulfate) were compared in 4 TI (hemoglobin <9 g/dL) and 6 control (hemoglobin 12-16 g/dL) patients. Serial serum iron concentrations were measured during the 24 hours following consumption of 1 mg/kg of elemental iron as ferritin or ferrous sulfate. Serum iron concentrations were also measured for one TI patient and one control patient 2 hours after the ingestion of 2 mg/kg of dietary iron in ferritin or ferrous sulfate. Maximum serum iron concentrations were observed 4 hours after the consumption of either dietary iron source. However, the serum iron values were unchanged for either dietary iron source, even at the higher doses of consumed iron. Thus, the bioavailability of dietary iron, either as ferritin or ferrous sulfate, was equivalent in both groups of patients. The pilot data support ferritin as an alternative dietary iron supplement to ferrous sulfate. ABBREVIATIONS CRP C-reactive protein; Hb hemoglobin; IDA iron-deficient anemia; ICP inductively coupled plasma; IE ineffective erythropoiesis; SCD sickle cell disease; sTf transferrin saturation; TI thalassemia intermedia; TIBC total iron binding capacity; TM thalassemia major; Tf transferrin.
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Affiliation(s)
- Monica Khurana
- a Department of Hematology/Oncology , UCSF Benioff Children's Hospital Oakland , Oakland , USA.,b Department of Hematology/Oncology , Children's Hospital Oakland Research Institute , Oakland , USA.,c Department of Hematology/Oncology , Riley Hospital for Children at Indiana University Health , Indianapolis , USA
| | - Ellen B Fung
- a Department of Hematology/Oncology , UCSF Benioff Children's Hospital Oakland , Oakland , USA.,b Department of Hematology/Oncology , Children's Hospital Oakland Research Institute , Oakland , USA
| | - Elliott P Vichinsky
- a Department of Hematology/Oncology , UCSF Benioff Children's Hospital Oakland , Oakland , USA.,b Department of Hematology/Oncology , Children's Hospital Oakland Research Institute , Oakland , USA
| | - Elizabeth C Theil
- b Department of Hematology/Oncology , Children's Hospital Oakland Research Institute , Oakland , USA
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Abstract
Blood transfusion plays a prominent role in the management of patients with sickle cell disease (SCD), but causes significant iron overload. As transfusions are used to treat the severe complications of SCD, it remains difficult to distinguish whether organ damage is a consequence of iron overload or is due to the complications treated by transfusion. Better management has resulted in increased survival, but prolonged exposure to iron puts SCD patients at greater risk for iron-related complications that should be treated. The success of chelation therapy is dominated by patient adherence to prescribed treatment; thus, adjustment of drug regimens to increase adherence to treatment is critical. This review will discuss the current biology of iron homeostasis in patients with SCD and how this informs our clinical approach to treatment. We will present the clinical approach to treatment of iron overload at our centre using serial assessment of organ iron by magnetic resonance imaging.
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Affiliation(s)
- Thomas D. Coates
- Hematology Section, Children’s Centre for Cancer, Blood Diseases and Bone Marrow Transplantation, University of Southern California, Los Angeles California, USA
| | - John C. Wood
- Division of Cardiology, at the Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles California, USA
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Ozturk Z, Genc GE, Gumuslu S. Minerals in thalassaemia major patients: An overview. J Trace Elem Med Biol 2017; 41:1-9. [PMID: 28347454 DOI: 10.1016/j.jtemb.2017.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 12/19/2016] [Accepted: 01/09/2017] [Indexed: 01/19/2023]
Abstract
Thalassaemia major (TM) is a hereditary blood disease characterised by reduced or absent production of beta globin chains. Erythrocyte transfusions are given to raise the haemoglobin level in patients with thalassaemia major. However, transfusions have been related to increased risk of iron overload and tissue damage related to excess iron. Both elevated oxidative stress due to iron overload and increased hemolysis lead to over utilisation of minerals required for antioxidant enzymes activities. Iron chelators have been used to prevent iron overload in thalassaemia major patients, but these chelators have the possibility of removing minerals from the body. Thalassaemia patients are more at risk for mineral deficiency because of increased oxidative stress and iron chelation therapies. Growth and maturational delay, cardiomyopathy, endocrinopathies and osteoporosis are the complications of thalassaemia. Minerals may play a particular role to prevent these complications. In the current review, we provide an overview of minerals including zinc (Zn), copper (Cu), selenium (Se), magnesium (Mg) and calcium (Ca) in thalassaemia major patients. We, also, underline that some complications of thalassaemia can be caused by an increased need for minerals or lack of the minerals.
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Affiliation(s)
- Zeynep Ozturk
- Department of Medical Biochemistry, Faculty of Medicine, Akdeniz University, Antalya, 07070, Turkey.
| | - Gizem Esra Genc
- Department of Medical Biochemistry, Faculty of Medicine, Akdeniz University, Antalya, 07070, Turkey.
| | - Saadet Gumuslu
- Department of Medical Biochemistry, Faculty of Medicine, Akdeniz University, Antalya, 07070, Turkey.
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Molazem Z, Noormohammadi R, Dokouhaki R, Zakerinia M, Bagheri Z. The Effects of Nutrition, Exercise, and a Praying Program on Reducing Iron Overload in Patients With Beta-Thalassemia Major: A Randomized Clinical Trial. IRANIAN JOURNAL OF PEDIATRICS 2017; 26:e3869. [PMID: 28203323 PMCID: PMC5297260 DOI: 10.5812/ijp.3869] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 04/20/2016] [Accepted: 05/08/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Excessive iron accumulation in the visceral organs creates problems for patients with beta-thalassemia major. Despite chelation therapy, mortality rate from the complications of this disease is still quite high. OBJECTIVES This study aimed to investigate the effectiveness of nutrition, exercise, and a praying program at reducing iron overload in patients with beta-thalassemia major. PATIENTS AND METHODS This randomized clinical trial assessed the effect of the designed care program on iron overload. The study was conducted in 38 patients with beta-thalassemia major who ranged in age from 15 - 35 years and had been referred to the largest center for thalassemic patients in Shiraz. The patients were randomly assigned to an intervention (n = 18) and a control (n = 20) group. Blood samples were collected from the participants before and two months after the intervention. Then, the data were statistically analyzed using chi-square, Fisher's exact test, Mann-Whitney U-test, Wilcoxon, independent samples t-test, and paired samples t-test. RESULTS The results showed that the mean level of serum ferritin significantly decreased in the intervention group two months after beginning the intervention. Also, the mean level of serum iron decreased in the intervention group, but the difference was not statistically significant. CONCLUSIONS The planned educational program could be used to reduce iron overload and ultimately improve the patients' health status.
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Affiliation(s)
- Zahra Molazem
- Community Based Nursing and Midwifery Research Center, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding author: Zahra Molazem, Community Based Nursing and Midwifery Research Center, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-9177154036, Fax: +98-7116474252, E-mail:
| | | | - Roya Dokouhaki
- Department of Nursing, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Maryam Zakerinia
- Department of Internal Medicine, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Zahra Bagheri
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, IR Iran
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Sungu JK, Mukuku O, Mutombo AM, Mawaw P, Aloni MN, Luboya ON. Trace elements in children suffering from sickle cell anemia: A case-control study. J Clin Lab Anal 2017; 32. [PMID: 28205320 DOI: 10.1002/jcla.22160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 01/09/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Information on serum albumin and trace elements among children suffering from Sickle Cell Anemia (SCA) was poorly documented in Africa. The aim of this study was to describe and to compare different values of trace elements with published reports from other parts of the world. METHODS We carried out a case-control study. Seventy-six steady state children suffering from SCA (Hb-SS). One hundred and fifty-two children were recruited with 76 (cases, Hb-SS) and 76 (control, Hb-AA) to compare the data. RESULTS The mean age was 10.0 years (SD=5.4) in SCA children and 9.2 years (SD=4.7) in the control group. The mean level of zinc and magnesium were slightly lower in the Hb-SS group than in the Hb-AA group (P<.001). CONCLUSION The first literature about trace elements in SCA is briefly reported in Central Africa. In our midst, zinc, magnesium, and selenium deficiencies underline the need for their systematic among all children with SCA to identify patients with these deficiencies and provide early management.
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Affiliation(s)
- Joseph K Sungu
- Department of Pediatrics, University Hospital of Lubumbashi, University of Lubumbashi, Kinshasa, the Democratic Republic of Congo
| | - Olivier Mukuku
- Department of Pediatrics, University Hospital of Lubumbashi, University of Lubumbashi, Kinshasa, the Democratic Republic of Congo
| | - Augustin Mulangu Mutombo
- Department of Pediatrics, University Hospital of Lubumbashi, University of Lubumbashi, Kinshasa, the Democratic Republic of Congo
| | - Paul Mawaw
- School of Public Health, University of Lubumbashi, Lubumbashi, the Democratic Republic of Congo
| | - Michel N Aloni
- Division of Hemato-oncology and Nephrology, Department of Paediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Oscar N Luboya
- Department of Pediatrics, University Hospital of Lubumbashi, University of Lubumbashi, Kinshasa, the Democratic Republic of Congo.,School of Public Health, University of Lubumbashi, Lubumbashi, the Democratic Republic of Congo
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Mazhar W, Farooq S, Iqbal A, Ansari SH, Choudhary MI, Atta-ur-Rahman AUR, Musharraf SG. Metallomic profiling to evaluate the response to drug treatment: hydroxyurea as a case study in β-thalassemia patients. RSC Adv 2017. [DOI: 10.1039/c6ra28514g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Metallomic profiles of β-thalassemia patients after hydroxyurea treatment reveal a reduction in biometal dysregulations.
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Affiliation(s)
- Wardah Mazhar
- H.E.J. Research Institute of Chemistry
- International Center for Chemical and Biological Sciences
- University of Karachi
- Karachi – 75270
- Pakistan
| | - Sabiha Farooq
- H.E.J. Research Institute of Chemistry
- International Center for Chemical and Biological Sciences
- University of Karachi
- Karachi – 75270
- Pakistan
| | - Ayesha Iqbal
- Dr Panjwani Center for Molecular Medicine and Drug Research
- International Center for Chemical and Biological Sciences
- University of Karachi
- Karachi – 75270
- Pakistan
| | - Saqib Hussain Ansari
- Department of Pediatric Hematology & Molecular Medicine
- National Institute of Blood Diseases and Bone Marrow Transplantation
- Karachi – 75300
- Pakistan
| | - M. Iqbal Choudhary
- H.E.J. Research Institute of Chemistry
- International Center for Chemical and Biological Sciences
- University of Karachi
- Karachi – 75270
- Pakistan
| | - Atta-ur-Rahman Atta-ur-Rahman
- H.E.J. Research Institute of Chemistry
- International Center for Chemical and Biological Sciences
- University of Karachi
- Karachi – 75270
- Pakistan
| | - Syed Ghulam Musharraf
- H.E.J. Research Institute of Chemistry
- International Center for Chemical and Biological Sciences
- University of Karachi
- Karachi – 75270
- Pakistan
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34
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Genc GE, Ozturk Z, Gumuslu S, Kupesiz A. Mineral Levels in Thalassaemia Major Patients Using Different Iron Chelators. Biol Trace Elem Res 2016; 170:9-16. [PMID: 26179086 DOI: 10.1007/s12011-015-0441-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/07/2015] [Indexed: 01/19/2023]
Abstract
The goal of the present study was to determine the levels of minerals in chronically transfused thalassaemic patients living in Antalya, Turkey and to determine mineral levels in groups using different iron chelators. Three iron chelators deferoxamine, deferiprone and deferasirox have been used to remove iron from patients' tissues. There were contradictory results in the literature about minerals including selenium, zinc, copper, and magnesium in thalassaemia major patients. Blood samples from the 60 thalassaemia major patients (the deferoxamine group, n = 19; the deferiprone group, n = 20 and the deferasirox group, n = 21) and the controls (n = 20) were collected. Levels of selenium, zinc, copper, magnesium, and iron were measured, and all of them except iron showed no significant difference between the controls and the patients regardless of chelator type. Serum copper levels in the deferasirox group were lower than those in the control and deferoxamine groups, and serum magnesium levels in the deferasirox group were higher than those in the control, deferoxamine and deferiprone groups. Iron levels in the patient groups were higher than those in the control group, and iron levels showed a significant correlation with selenium and magnesium levels. Different values of minerals in thalassaemia major patients may be the result of different dietary intake, chelator type, or regional differences in where patients live. That is why minerals may be measured in thalassaemia major patients at intervals, and deficient minerals should be replaced. Being careful about levels of copper and magnesium in thalassaemia major patients using deferasirox seems to be beneficial.
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Affiliation(s)
| | - Zeynep Ozturk
- Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Saadet Gumuslu
- Faculty of Medicine, Akdeniz University, Antalya, Turkey.
| | - Alphan Kupesiz
- Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Singer ST, Killilea D, Suh JH, Wang ZJ, Yuan Q, Ivani K, Evans P, Vichinsky E, Fischer R, Smith JF. Fertility in transfusion-dependent thalassemia men: effects of iron burden on the reproductive axis. Am J Hematol 2015; 90:E190-2. [PMID: 26044409 DOI: 10.1002/ajh.24083] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 01/12/2023]
Affiliation(s)
- Sylvia T. Singer
- Department of Hematology/Oncology; Children's Hospital and Research Center at Oakland; California
| | - David Killilea
- Children's Hospital Oakland Research Institute; Oakland California
| | - Jung H. Suh
- Children's Hospital Oakland Research Institute; Oakland California
| | - Zhiyue Jerry Wang
- Department of Radiology; Children's Medical Center of Dallas and UT Southwestern Medical; Dallas Texas
| | - Qing Yuan
- Department of Radiology; Children's Medical Center of Dallas and UT Southwestern Medical; Dallas Texas
| | - Kristen Ivani
- Reproductive Science Center (RSC) of the SF Bay Area; San Ramon California
| | - Patricia Evans
- Research Department of Haematology; University College London; London WC1E 6BT United Kingdom
| | - Elliott Vichinsky
- Department of Hematology/Oncology; Children's Hospital and Research Center at Oakland; California
| | - Roland Fischer
- Pediatric Hematology/Oncology; University Medical Center Hamburg-Eppendorf; Hamburg Delaware
| | - James F. Smith
- Department of Urology; University of California; San Francisco California
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36
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Elalfy MS, Saber MM, Adly AAM, Ismail EA, Tarif M, Ibrahim F, Elalfy OM. Role of vitamin C as an adjuvant therapy to different iron chelators in young β-thalassemia major patients: efficacy and safety in relation to tissue iron overload. Eur J Haematol 2015; 96:318-26. [PMID: 26018112 DOI: 10.1111/ejh.12594] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Vitamin C, as antioxidant, increases the efficacy of deferoxamine (DFO). AIM To investigate the effects of vitamin C as an adjuvant therapy to the three used iron chelators in moderately iron-overloaded young vitamin C-deficient patients with β-thalassemia major (β-TM) in relation to tissue iron overload. METHODS This randomized prospective trial that included 180 β-TM vitamin C-deficient patients were equally divided into three groups (n = 60) and received DFO, deferiprone (DFP), and deferasirox (DFX). Patients in each group were further randomized either to receive vitamin C supplementation (100 mg daily) or not (n = 30). All patients received vitamin C (group A) or no vitamin C (group B) were followed up for 1 yr with assessment of transfusion index, hemoglobin, iron profile, liver iron concentration (LIC) and cardiac magnetic resonance imaging (MRI) T2*. RESULTS Baseline vitamin C was negatively correlated with transfusion index, serum ferritin (SF), and LIC. After vitamin C therapy, transfusion index, serum iron, SF, transferrin saturation (Tsat), and LIC were significantly decreased in group A patients, while hemoglobin and cardiac MRI T2* were elevated compared with baseline levels or those in group B without vitamin C. The same improvement was found among DFO-treated patients post-vitamin C compared with baseline data. DFO-treated patients had the highest hemoglobin with the lowest iron, SF, and Tsat compared with DFP or DFX subgroups. CONCLUSIONS Vitamin C as an adjuvant therapy possibly potentiates the efficacy of DFO more than DFP and DFX in reducing iron burden in the moderately iron-overloaded vitamin C-deficient patients with β-TM, with no adverse events.
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Affiliation(s)
- Mohsen S Elalfy
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Maha M Saber
- Child Health in Complementary Medicine, National Research Center, Cairo, Egypt
| | | | - Eman A Ismail
- Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Tarif
- Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Fatma Ibrahim
- Child Health in Complementary Medicine, National Research Center, Cairo, Egypt
| | - Omar M Elalfy
- Child Health in Complementary Medicine, National Research Center, Cairo, Egypt
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Abstract
Iron overload is becoming an increasing problem as haemoglobinopathy patients gain greater access to good medical care and as therapies for myelodysplastic syndromes improve. Therapeutic options for iron chelation therapy have increased and many patients now receive combination therapies. However, optimal utilization of iron chelation therapy requires knowledge not only of the total body iron burden but the relative iron distribution among the different organs. The physiological basis for extrahepatic iron deposition is presented in order to help identify patients at highest risk for cardiac and endocrine complications. This manuscript reviews the current state of the art for monitoring global iron overload status as well as its compartmentalization. Plasma markers, computerized tomography, liver biopsy, magnetic susceptibility devices and magnetic resonance imaging (MRI) techniques are all discussed but MRI has come to dominate clinical practice. The potential impact of recent pancreatic and pituitary MRI studies on clinical practice are discussed as well as other works-in-progress. Clinical protocols are derived from experience in haemoglobinopathies but may provide useful guiding principles for other iron overload disorders, such as myelodysplastic syndromes.
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Affiliation(s)
- John C Wood
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA
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38
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Selenium and Vitamin E as antioxidants in chronic hemolytic anemia: Are they deficient? A case-control study in a group of Egyptian children. J Adv Res 2015; 6:1071-7. [PMID: 26644944 PMCID: PMC4642188 DOI: 10.1016/j.jare.2015.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 12/30/2014] [Accepted: 01/07/2015] [Indexed: 12/31/2022] Open
Abstract
Accelerated oxidative damage is one of the hallmarks in both sickle cell disease (SCD) and thalassemia major (TM). A decreased antioxidant level is found in both diseases. Our study was carried out to evaluate the variation in serum levels of Selenium and Vitamin E among a group of transfusion dependant Egyptian SCD and TM patients, further more to correlate these levels with iron overload status or transfusion requirements. A case-control study was conducted at the Cairo University Pediatric Hospital to assess the serum levels of Selenium using Atomic Absorption Spectrometer and Vitamin E using commercially available ELISA Kit in transfusion dependent children, 30 with beta thalassemia and 30 with SCD in a steady state aged from 6 to 18 years, these findings were compared to 30 age/sex matched healthy controls. Our results revealed a depleted antioxidants level in the studied group of Egyptian children with TM and SCD relative to healthy controls (P < 0.05). A significant positive correlation was found between Vitamin E levels and ferritin (r = 0.26, p = 0.047) in SCD and TM patients. Nonsignificant correlation was detected between serum Selenium and Vitamin E. Moreover, values of these antioxidants did not correlate with indices of hemolysis nor with those of inflammation in chronically transfused TM and SCD patients.
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Mashhadi MA, Heidari Z, Sepehri Z, Bakhshipour AR, Karimkoshte A. The selenium status in thalassemia patients in South East of iran. Int J Hematol Oncol Stem Cell Res 2014; 8:1-4. [PMID: 25774261 PMCID: PMC4345292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 08/15/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION There are limited reports about selenium status in major thalassemia patients. The aim of this study is evaluation of selenium status in patients with major thalassemia south east of Iran with large sample size and wide range of age. This study compared selenium status with other sites of the world. METHODS In this study 369 cases that had major thalassemia for more than 5 years were enrolled in the study. Selenium level was measured in all eligible patients after 12 hours fasting by graphite enstrum furnace atomic absorption spectrometry in south east of Iran in 2012. RESULTS Of 369 cases, 333 eligible patients were evaluated. Mean age was 15.63±7.4 years. One hundred ninety two cases were male and others were female (141 Cases). About 27% (90) of the cases were 5-10 years-old, 24 % (80) were 10-15 years-old and 49% were more than 15 years-old. Iron chelator in 62.2% was Dessferrioxamine, in 15.5% was Deferiprone and in 22.3% was combination of Dessferioxamine and Deferiprone. Totally 85 cases (25.52%) had Selenium deficiency, 35.43% (118 cases) had normal levels and 39 %(130 cases) had selenium excess. CONCLUSION Our study on 333 major thalassemia cases documented variable status of selenium from deficiency to higher than normal levels. It was different with other reports in the world.
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Affiliation(s)
- Mohammad Ali Mashhadi
- Health promotion research Center, Zahedan University of medical sciences, Zahedan, Iran
| | - Zahra Heidari
- Department of internal medicine, Ali Ebne Abitaleb Hospital, Zahedan University of medical sciences, Zahedan, Iran
| | - Zahra Sepehri
- Department of internal medicine, Amir Al Momenin Hospital, Zabol University of medical sciences, Zabol, Iran
| | - Ali Reza Bakhshipour
- Department of internal medicine, Ali Ebne Abitaleb Hospital, Zahedan University of medical sciences, Zahedan, Iran
| | - Azra Karimkoshte
- Department of internal medicine, Ali Ebne Abitaleb Hospital, Zahedan University of medical sciences, Zahedan, Iran
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40
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Mashhadi MA, Sepehri Z, Heidari Z, Shirzaee E, Kiani Z. The prevalence of zinc deficiency in patients with thalassemia in South East of iran, sistan and baluchistan province. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e6243. [PMID: 25389495 PMCID: PMC4222021 DOI: 10.5812/ircmj.6243] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 06/27/2013] [Accepted: 07/14/2014] [Indexed: 12/02/2022]
Abstract
Background: There are different and controversial reports about zinc deficiency in patients with major thalassemia. Objectives: The aim of this study was to evaluate zinc status in patients with major thalassemia in Sistan and Baluchistan province, southeastern Iran. Patients and Methods: The study was performed in Ali Asghar Hospital, a specialized governmental hospital located in Zahedan, Iran. In this cross-sectional study, 369 patients with a history of major thalassemia for more than 5 years entered the study using convenience sampling method. Thirty-six subjects were excluded from the study based on our exclusion criteria. Zinc level was measured in all patients after 12 hours fasting using atomic absorption spectrometry method in 2012. Results: Of 369 cases, 333 patients were eligible and evaluated. The mean age was 15.63 ± 7.4 years. One hundred ninety two cases were male and others were female (141 cases). About 27% (90) of the cases were 5-10 years-old, 24% (80) were 10-15 years-old and 49% were older than 15 years old. Iron chelator in 65.46% was Desferrioxamine, in 28.2% was Deferasirox and in 19.5% was combination of Desferrioxamine and Deferiprone. All cases had zinc deficiency, and 98.5% had severe zinc deficiency. Others (1.5%) had mild deficiency. Conclusions: Our study on 333 patients with major thalassemia documented severe zinc deficiency in all cases. We had no cases with normal or increased zinc levels. It was different with other reports in the world.
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Affiliation(s)
- Mohammad Ali Mashhadi
- Department of Hematology and Oncology, Ali Ebne Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Zahra Sepehri
- Department of Internal Medicine, Amir Al-Momenin Hospital, Zabol University of Medical Sciences, Zabol, IR Iran
- Corresponding Author: Zahra Sepehri, Department of Internal Medicine, Amir Al-Momenin Hospital, Zabol University of Medical Sciences, Zabol, IR Iran. Tel: +98-9126880468, E-mail:
| | - Zahra Heidari
- Department of Internal Medicine, Ali Ebne Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Eghbal Shirzaee
- Department of Internal Medicine, Ali Ebne Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Zohre Kiani
- Kerman University of Medical Sciences, Kerman, IR Iran
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Coates TD. Physiology and pathophysiology of iron in hemoglobin-associated diseases. Free Radic Biol Med 2014; 72:23-40. [PMID: 24726864 PMCID: PMC4940047 DOI: 10.1016/j.freeradbiomed.2014.03.039] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 03/26/2014] [Accepted: 03/27/2014] [Indexed: 01/19/2023]
Abstract
Iron overload and iron toxicity, whether because of increased absorption or iron loading from repeated transfusions, can be major causes of morbidity and mortality in a number of chronic anemias. Significant advances have been made in our understanding of iron homeostasis over the past decade. At the same time, advances in magnetic resonance imaging have allowed clinicians to monitor and quantify iron concentrations noninvasively in specific organs. Furthermore, effective iron chelators are now available, including preparations that can be taken orally. This has resulted in substantial improvement in mortality and morbidity for patients with severe chronic iron overload. This paper reviews the key points of iron homeostasis and attempts to place clinical observations in patients with transfusional iron overload in context with the current understanding of iron homeostasis in humans.
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Affiliation(s)
- Thomas D Coates
- Children׳s Center for Cancer and Blood Diseases, Children׳s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA 90027, USA.
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Nutritional biomarkers in children and adolescents with Beta-thalassemia-major: An Egyptian center experience. BIOMED RESEARCH INTERNATIONAL 2014; 2014:261761. [PMID: 24812610 PMCID: PMC4000941 DOI: 10.1155/2014/261761] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 03/14/2014] [Accepted: 03/24/2014] [Indexed: 11/18/2022]
Abstract
Background and Aim. Trace elements and vitamins play a vital role in human body to perform its function properly. Thalassemic patients are at risk of micronutrient deficiency. This study estimated levels of vitamins A, C, E, B12, folic acid, total homocysteine (tHcy), and methylmalonic acid (MMA) along with trace elements, zinc, copper, and selenium in Beta-thalassemia-major patients. Methods. This study included 108 patients with Beta-thalassemia-major and 60 age and sex matched healthy children. Serum levels of vitamin A, E, C, tHcy, and MMA were estimated by high pressure liquid chromatography while serum levels of folic acid and B12 were estimated by thin layer chromatography. Serum zinc, copper, and selenium were determined by atomic absorption spectrometry. Results. There was a significant decrease of vitamins A, C, E, and B12 and trace elements zinc, copper, and selenium in thalassemic patients as compared to controls. tHcy and MMA were significantly elevated in patients. No significant correlations were found between the serum levels of the studied vitamins and trace elements as regards age, frequency of transfusion, duration of transfusion, and serum ferritin. Conclusion. The level of various nutritional biomarkers (vitamins A, C, E, and B12 and trace elements zinc, copper, selenium) was reduced in chronically transfused Egyptian thalassemic patient. These patients should have periodic nutritional evaluation and supplementation. Multicenter studies are highly recommended.
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van Zwieten R, Verhoeven AJ, Roos D. Inborn defects in the antioxidant systems of human red blood cells. Free Radic Biol Med 2014; 67:377-86. [PMID: 24316370 DOI: 10.1016/j.freeradbiomed.2013.11.022] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 11/20/2013] [Accepted: 11/22/2013] [Indexed: 12/25/2022]
Abstract
Red blood cells (RBCs) contain large amounts of iron and operate in highly oxygenated tissues. As a result, these cells encounter a continuous oxidative stress. Protective mechanisms against oxidation include prevention of formation of reactive oxygen species (ROS), scavenging of various forms of ROS, and repair of oxidized cellular contents. In general, a partial defect in any of these systems can harm RBCs and promote senescence, but is without chronic hemolytic complaints. In this review we summarize the often rare inborn defects that interfere with the various protective mechanisms present in RBCs. NADPH is the main source of reduction equivalents in RBCs, used by most of the protective systems. When NADPH becomes limiting, red cells are prone to being damaged. In many of the severe RBC enzyme deficiencies, a lack of protective enzyme activity is frustrating erythropoiesis or is not restricted to RBCs. Common hereditary RBC disorders, such as thalassemia, sickle-cell trait, and unstable hemoglobins, give rise to increased oxidative stress caused by free heme and iron generated from hemoglobin. The beneficial effect of thalassemia minor, sickle-cell trait, and glucose-6-phosphate dehydrogenase deficiency on survival of malaria infection may well be due to the shared feature of enhanced oxidative stress. This may inhibit parasite growth, enhance uptake of infected RBCs by spleen macrophages, and/or cause less cytoadherence of the infected cells to capillary endothelium.
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Affiliation(s)
- Rob van Zwieten
- Laboratory of Red Blood Cell Diagnostics, Department of Blood Cell Research, Sanquin Blood Supply Organization, 1066 CX Amsterdam, The Netherlands.
| | - Arthur J Verhoeven
- Department of Medical Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Dirk Roos
- Laboratory of Red Blood Cell Diagnostics, Department of Blood Cell Research, Sanquin Blood Supply Organization, 1066 CX Amsterdam, The Netherlands
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Abiodun EM, Aisha KG. The association of transfusion status with antioxidant enzymes and malondialdehyde level in Nigerians with sickle cell disease. Asian J Transfus Sci 2014; 8:47-50. [PMID: 24678175 PMCID: PMC3943147 DOI: 10.4103/0973-6247.126692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Sickle cell disease (SCD) often leads to chronic hemolytic anemia of varying severity, and blood transfusion may be employed in the management of SCD complications. OBJECTIVE The aim of the study was to evaluate the effect of blood transfusion on the activities of some antioxidant enzymes as well as lipid peroxide and to relate transfusion status to these enzymes and malondialdehyde (MDA) in SCD patients. MATERIALS AND METHODS Glutathione peroxidase (GPX), superoxide dismutase, catalase, MDA, and lipoproteins were assayed in 87 SCD and 20 age- and sex-matched subjects with normal hemoglobin. Of the 87 SCD patients, 30 had multiple transfusions, 21 had been transfused once while 36 had not been transfused within the last 3 months. RESULTS Statistically significant decrease in the mean levels of GPX (P = 0.045) and Cu/Zn SOD (P = 0.001) and increased (P = 0.001) MDA were observed in the transfused compared to non-transfused patients. Similarly, significant decrease (P = 0.001) in Cu/Zn SOD and increase (P = 0.01) in MDA were observed in multi transfused compared to those who had been transfused once. Transfusion status correlated (P <0.047) inversely with Cu/Zn SOD and positively with MDA. CONCLUSION Reduced activity levels of serum antioxidant enzymes and increased mean levels of MDA were observed in transfused compared to non-transfused SCD patients and these changes correlated with transfusion status.
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Affiliation(s)
- Emokpae Mathias Abiodun
- Department of Chemical Pathology, Bayero University Aminu Kano Teaching Hospital, Kano, Nigeria
- Medical Laboratory Science, School of Basic Medical Sciences, College of Medical Sciences, University of Benin, Benin City, Nigeria
| | - Kuliya-Gwarzo Aisha
- Department of Haematology and Blood Transfusion, Bayero University Aminu Kano Teaching Hospital, Kano, Nigeria
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Ghahramanlu E, Banihashem A, Mirhossini NZ, Hosseini G, Mostafavi-Toroghi H, Tavallaie S, Meshkat M, Ghayour-Mobarhan M, Ferns G. Effect of zinc supplementation on serum antibody titers to heat shock protein 27 in patients with thalassemia major. Hematology 2013; 19:113-9. [DOI: 10.1179/1607845413y.0000000099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Elham Ghahramanlu
- Blood Transfusion Research CenterHigh Institute for Research and Education in Transfusion Medicine, North Khorasan, Iran
| | - Abdollah Banihashem
- Hematology DepartmentSheikh Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naghme-Zahra Mirhossini
- Biochemistry of Nutrition Research Center and Cardiovascular Research Center Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Golkoo Hosseini
- Biochemistry of Nutrition Research Center and Cardiovascular Research Center Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hesam Mostafavi-Toroghi
- Biochemistry of Nutrition Research Center and Cardiovascular Research Center Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shima Tavallaie
- Biochemistry of Nutrition Research Center and Cardiovascular Research Center Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Meshkat
- Department of BiostatisticsIslamic Azad University, Mashhad Branch, Mashhad, Iran
| | - Majid Ghayour-Mobarhan
- Biochemistry of Nutrition Research Center and Cardiovascular Research Center Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon Ferns
- Institute for Science & Technology in Medicine, Faculty of Health, University of Keele, Staffordshire ST4 7QB, UK
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Said Othman KM, Elshazly SA, Heiba NM. Role of non-invasive assessment in prediction of preclinical cardiac affection in multi-transfused thalassaemia major patients. ACTA ACUST UNITED AC 2013; 19:380-7. [PMID: 24225039 DOI: 10.1179/1607845413y.0000000140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND The principal cause of mortality and morbidity in β-thalassemia major (β-TM) is the iron overload as these patients receive about 20 times the normal intake of iron, which leads to iron accumulation and damage in the liver, heart, and endocrine organs. Chronically transfused patients used to die from cardiac iron overload in their teens and twenties. Monitoring of iron status through cardiac magnetic resonance imaging (CMRI) has replaced the conventional methods of assessment, yet this modality is not readily available in centers where the disease distribution is maximal. Objectives The aim of this work is to study some simple non-invasive tools and their abilities to predict preclinical cardiac affection reflecting cardiac iron deposition (CID) in multi-transfused β-TM patients taking the T2* CMRI as a gold standard reference test. METHODS One hundred consecutive multi-transfused, clinically stable β-TM patients with age ranging from 16 to 30 years (mean ± SD, 21.1 ± 3.9) were included in this study. Assessment of serum ferritin, serum hepcidin, and high-sensitivity C-reactive protein as well as cardiac assessment by echo-doppler and 24-hour Holter were used to predict CID, and consequently predict preclinical cardiac affection, in reference to CMRI results as the standard method of cardiac iron assessment. RESULTS According to CMRI results, patients were subdivided into a group of 42 patients with detectable myocardial iron (T*≤ 20 ms) and a group of 58 patients with no detectable myocardial iron (T* > 20 ms). No differences in age, gender, or distribution of splenectomized patients were observed between both groups. Patients with detectable myocardial iron received significantly higher number of transfusions per year than those with no detectable myocardial iron (mean ± SD, 14.6 ± 1.7 vs. 12.5 ± 1.7; P < 0.001) yet comparable levels of serum ferritin, serum hepcidin, and hepcidin/ferritin ratio (P > 0.05) were noted. Cardiac iron detection was associated with significantly lower heart rate (mean ± SD, 75 ± 6.1 vs. 80 ± 6.9; P < 0.001), lower left ventricular ejection fraction (LVEF) (mean ± SD 60.1 ± 3.2 vs. 70.1 ± 2.8; P < 0.001), and higher total number of premature ventricular contractions (PVCs) (median 78 vs. 14; P < 0.001). The group with CID comprised significantly more patients with left ventricular diastolic dysfunction (15/42, 35.7% vs. 3/58, 5.2%; P < 0.001); PVCs ≥10/hour (13/42, 31% vs. 2/58, 3.4%; P < 0.001); episodes of sinus pauses (6/42, 14.3% vs. 1/58, 1.7%; P < 0.05); episodes of high-grade atrio-ventricular block (5/42, 11.9% vs. 1/58, 1.7%; P < 0.05) compared to the group with no (CID). In presence of normal LVEF, detection of 10 or more PVCs per hour was the most predictive of cardiac iron loading with a positive predictive value of 86.7% and specificity of 96.6%, and the highest likelihood ratio (9.09). Detection of more than 22 PVCs/24 hours had the best sensitivity (81%) and the best negative predictive value (84%). The positive likelihood ratio of the studied parameters was highest in case of presence of PVCs ≥10/hour and lowest in case of average heart rate with a cut-off level of ≤77.5 bpm (9.09 and 1.46, respectively). CONCLUSION Our results support our hypothesis that monitoring β-TM patients with echo and Holter electrocardiogram can help in the detection of preclinical cardiac affection in centers lacking cardiac MRI; however, due to relatively low sensitivity they can not fully replace CMRI. Further work is needed to identify additional simple parameters that can form a diagnostic model with adequate sensitivity.
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Nakavachara P, Viprakasit V. Children with hemoglobin E/β-thalassemia have a high risk of being vitamin D deficient even if they get abundant sun exposure: a study from Thailand. Pediatr Blood Cancer 2013; 60:1683-8. [PMID: 23733667 DOI: 10.1002/pbc.24614] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/02/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Vitamin D is a key component in calcium homeostasis, bone mineralization and immune function, and people with a vitamin D deficiency may therefore be at higher risk of osteoporosis, osteopenia, delayed growth and fractures. Vitamin D deficiency is a known clinical complication of patients with β-thalassemia major; however, as yet there are limited data on the vitamin D status of patients with Hb E/β-thalassemia. Hb E/β-thalassemia is characterized by a wide clinical heterogeneity ranging from non-transfusion dependency to transfusion dependency. Because patients with Hb E/β-thalassemia are so clinically diverse, the prevalence of vitamin D deficiency might differ among Hb E/β-thalassemia patients. PROCEDURE We investigated the vitamin D status of 109 children with Hb E/β-thalassemia who attended the Pediatric Hematology Clinic at the Siriraj Hospital in Bangkok, Thailand, from April 2009 to March 2010. RESULTS Forty-nine of the children were classified as transfusion-dependent (TD) and the remainder (n = 60) as non-transfusion-dependent (NTD). Only 10.1% of the children in our study had normal vitamin D levels, despite Thailand's geographic position 15° N and 100° E and climate, which provides abundant sunlight exposure and therefore efficient vitamin D synthesis. In addition, NTD children were significantly more likely to be vitamin D deficient than TD children (P = 0.01). CONCLUSIONS Our results highlight the importance of monitoring serum vitamin D levels in children with Hb E/β-thalassemia regardless of their clinical severity or the amount of sunlight they are exposed to.
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Affiliation(s)
- Pairunyar Nakavachara
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Fung EB, Kwiatkowski JL, Huang JN, Gildengorin G, King JC, Vichinsky EP. Zinc supplementation improves bone density in patients with thalassemia: a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr 2013; 98:960-71. [PMID: 23945720 PMCID: PMC3778866 DOI: 10.3945/ajcn.112.049221] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 07/17/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patients with thalassemia major (Thal) frequently have low plasma zinc, which has been associated with low bone mass. OBJECTIVE The objective was to determine the effect of zinc supplementation on bone mass in patients with Thal. DESIGN Forty-two subjects (21 females aged 10-30 y) with Thal and low bone mass were randomly assigned to receive 25 mg Zn/d or placebo. Bone mineral content (BMC) and areal bone mineral density (aBMD) were assessed by using dual-energy X-ray absorptiometry, and fasting blood was collected for the measurement of plasma zinc at 0, 12, and 18 mo. RESULTS Thirty-two subjects, 81% of whom were transfusion dependent, completed the study (mean ± SD: 17.1 ± 5.2 y). Plasma zinc was ≤70 μg/dL in 11 subjects at baseline and increased significantly with zinc supplementation (P = 0.014). Use of intention-to-treat analysis and linear models for longitudinal data, adjusted for baseline and pubertal stage, showed that the zinc group had significantly greater increases in whole-body BMC (adjusted mean ± SE: 63 ± 15 g; P = 0.02), and aBMD (0.023 ± 0.006 g/cm(2); P = 0.04) than did the placebo group after 18 mo. Furthermore, adjusted spine and hip aBMD z scores each decreased by 0.3 SDs (both P = 0.04) in the placebo compared with the zinc group over the 18-mo study. CONCLUSIONS In young patients with Thal, zinc supplementation resulted in greater gains in total-body bone mass than did placebo. Zinc was well tolerated and is worthy of investigation in larger trials in Thal patients across a range of ages and disease severity. This trial was registered at clinicaltrials.gov as NCT00459732.
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Affiliation(s)
- Ellen B Fung
- Departments of Hematology at the Children's Hospital & Research Center, Oakland, CA and the Children's Hospital Oakland Research Institute, Oakland, CA
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Pennell DJ, Udelson JE, Arai AE, Bozkurt B, Cohen AR, Galanello R, Hoffman TM, Kiernan MS, Lerakis S, Piga A, Porter JB, Walker JM, Wood J. Cardiovascular function and treatment in β-thalassemia major: a consensus statement from the American Heart Association. Circulation 2013; 128:281-308. [PMID: 23775258 DOI: 10.1161/cir.0b013e31829b2be6] [Citation(s) in RCA: 261] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This aim of this statement is to report an expert consensus on the diagnosis and treatment of cardiac dysfunction in β-thalassemia major (TM). This consensus statement does not cover other hemoglobinopathies, including thalassemia intermedia and sickle cell anemia, in which a different spectrum of cardiovascular complications is typical. There are considerable uncertainties in this field, with a few randomized controlled trials relating to treatment of chronic myocardial siderosis but none relating to treatment of acute heart failure. The principles of diagnosis and treatment of cardiac iron loading in TM are directly relevant to other iron-overload conditions, including in particular Diamond-Blackfan anemia, sideroblastic anemia, and hereditary hemochromatosis. Heart failure is the most common cause of death in TM and primarily results from cardiac iron accumulation. The diagnosis of ventricular dysfunction in TM patients differs from that in nonanemic patients because of the cardiovascular adaptation to chronic anemia in non-cardiac-loaded TM patients, which includes resting tachycardia, low blood pressure, enlarged end-diastolic volume, high ejection fraction, and high cardiac output. Chronic anemia also leads to background symptomatology such as dyspnea, which can mask the clinical diagnosis of cardiac dysfunction. Central to early identification of cardiac iron overload in TM is the estimation of cardiac iron by cardiac T2* magnetic resonance. Cardiac T2* <10 ms is the most important predictor of development of heart failure. Serum ferritin and liver iron concentration are not adequate surrogates for cardiac iron measurement. Assessment of cardiac function by noninvasive techniques can also be valuable clinically, but serial measurements to establish trends are usually required because interpretation of single absolute values is complicated by the abnormal cardiovascular hemodynamics in TM and measurement imprecision. Acute decompensated heart failure is a medical emergency and requires urgent consultation with a center with expertise in its management. The first principle of management of acute heart failure is control of cardiac toxicity related to free iron by urgent commencement of a continuous, uninterrupted infusion of high-dose intravenous deferoxamine, augmented by oral deferiprone. Considerable care is required to not exacerbate cardiovascular problems from overuse of diuretics or inotropes because of the unusual loading conditions in TM. The current knowledge on the efficacy of removal of cardiac iron by the 3 commercially available iron chelators is summarized for cardiac iron overload without overt cardiac dysfunction. Evidence from well-conducted randomized controlled trials shows superior efficacy of deferiprone versus deferoxamine, the superiority of combined deferiprone with deferoxamine versus deferoxamine alone, and the equivalence of deferasirox versus deferoxamine.
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Erdoğan E, Canatan D, Ormeci AR, Vural H, Aylak F. The effects of chelators on zinc levels in patients with thalassemia major. J Trace Elem Med Biol 2013; 27:109-11. [PMID: 23164519 DOI: 10.1016/j.jtemb.2012.10.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 10/01/2012] [Accepted: 10/17/2012] [Indexed: 11/28/2022]
Abstract
Zinc which is an essential element has very important effects on growth and immune system in patients with thalassemia major (TM). The effects of two oral iron chelator agents, desferrioxamine (DFO) and deferiprone (DFP), on zinc levels were investigated in previous studies and they were found to cause zinc deficiency. Zinc level alteration by the new chelator deferasirox (DFX) is not present in the literature. The aim of this study was to examine the effects of different oral chelators on serum and urine zinc levels in TM patients. Zinc levels are compared in the patients who received different chelators: only DFX, combined chelation with DFO plus DFP and the healthy control group. A total of 56 patients with TM were involved in this study: 39 patients received only DFX and 17 patients were given combined treatment DFO+DFP between August 2008 and August 2009. In addition, a control group was established from the healthy population. Blood was taken from all the patients for serum zinc levels and 24hour-urine samples were collected for urine zinc levels. Serum zinc levels were found to be 64.8±14.8μg/dL in DFX group and 66.5±15.1μg/dL in DFO+DFP group. These levels were statistically lower than that in the control group (149±54.3μg/dL) (p<0.05), but there was no statistically difference between the two different chelation groups (p>0.05). The urine zinc levels of DFX and DFO+DFP group were 662.2±428.2μg/day and 1182.3±980.3μg/day respectively (p<0.05). Urinary zinc excretion in the chelation groups (DFX and DFO+DFP) was significantly higher than the control group (395.1±208.9μg/day) (p<0.05). As a conclusion, the new chelation agent, DFX, also leads to zinc deficiency, though its urinary zinc excretion is lower. New studies are required to examine the effects of DFX on zinc extensively. Zinc levels of patients with TM should be followed up regularly and zinc supply should be given at early ages.
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Affiliation(s)
- Elvan Erdoğan
- Department of Pediatrics, Suleyman Demirel University, Isparta, Turkey
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