Relationship between serum ferritin and zinc levels in patients with major thalassemia

Hervita Yeni; Finny Fitry Yani; Amirah Zatil Izzah; Gustina Lubis

doi:10.14238/pi59.3.2019.144-9

Hervita Yeni Pediatric Specialist Education Program Andalas University
Finny Fitry Yani
Amirah Zatil Izzah
Gustina Lubis

DOI: https://doi.org/10.14238/pi59.3.2019.144-9

Keywords: thalassemia; ferritin; zinc

Abstract

Background In thalassemia patients, reduced zinc absorption results from increased serum iron due to repeated blood transfusions, increased iron absorption due to ineffective erythropoiesis, and competitive inhibition between iron and zinc in binding to transferrin, a means of transporting both types of minerals in the blood. Few studies have been done to examine zinc levels in thalassemia patients and its relationship with ferritin.

Objective To compare serum zinc in thalassemia patients and healthy controls and to assess for a possible correlation between serum ferritin and zinc in thalassemia patients.

Methods This cross-sectional study in 68 subjects was done from October 2016 to August 2017. Serum ferritin measured by chemiluminescence immunoassay and serum zinc by inductively coupled plasma mass spectrometry (ICP-MS). Wilcoxon test was used to analyze for differences between serum zinc in thalassemia patients and controls. Spearmanâ€™s correlation test was used to analyze for a possible correlation between ferritin and serum zinc in thalassemia patients.

Results There were 34 patients with thalassemia and 34 healthy control subjects. The median serum zinc was 119.34 Âµg/dL (IQR=71.27) in the thalassemia group and 120.08 Âµg/dL (IQR=26.28) in the control group (P=0.36). There was no significant correlation between serum ferritin and zinc in thalassemic children (r=-0.023; P=0.895).

Conclusion There is no significant difference in serum zinc levels between thalassemic children and healthy controls. There is no significant correlation between serum ferritin and zinc in thalassemic children.

References

1. Permono B, Ugrasena D. Talasemia. In: Permono B, Sutaryo, Ugrasena I, et al. (eds). Buku Ajar Hematologi-Onkologi Anak. Jakarta: BP IDAI; 2006, p. 64–83.
2. Wahidiyat I. Thalassemia dan permasalahannya di Indonesia. Sari Pediatr 2003; 5: 2–3.
3. Weatherall J. The thalassemias. In: William W, Beutler E, Erslev A, et al. (eds) Hematology. Philadelphia: Mc Graw-Hill; 1998. p. 890–9.
4. Talluri SB, Datta V, Guttula SGB. An overview on thalassemia. Int Res J Invent Pharm Sci. 2013;1:1–12.
5. Claster S, Wood JC, Noetzli L, Carson SM, Hofstra TC, Khanna R, et al. Nutritional deficiencies in iron overloaded patients with hemoglobinopathies. 2009; 84: 344–8.
6. Marengo-Rowe AJ. The thalassemias and related disorders. Baylor Univ Med Cent. 2007; 20: 27–31.
7. Shamshirsaz AA, Bekheirnia MR, Kamgar M, Pourzahedgilani N, Bouzari N, Habibzadeh M, et al. Metabolic and endocrinologic complications in beta-thalassemia major: A multicenter study in Tehran. BMC Endocr Disord. 2003; 3: 4
8. Brown KH. Commentary: Zinc and child growth. Int J Epidemiol 2003; 32: 1103–4.
9. Brown KH, Wuehler SE, Peerson JM. The importance of zinc in human nutrition and estimation of the global prevalence of zinc defi ciency Zinc in the environment and in biology. Food Nutr Bull 2001; 22: 113–25.
10. Arcasoy A, Canatan D, Sinav B, Kutlay L, Oouz N. Serum zinc levels and zinc binding capacity in thalassemia. J Trace Elem Med Biol. 2001;15: 85–7.
11. 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. Iran Red Crescent Med J. 2014;16: 1–4.
12. Nidumuru S, Boddula V, Vadakedath S, Kolanu BR, Kandi V. Evaluating the Role of Zinc in Beta Thalassemia Major: A Prospective Case-Control Study from a Tertiary Care Teaching Hospital in India. Cureus. 2017;9: e1495.
13. Sultan S, Irfan SM, Kakar J, Zeeshan R. Effect of iron chelator desferrioxamine on serum zinc levels in patients with beta thalassemia major. Malays J Pathol. 2015;37: 35–8.
14. Banihashem A, Ghahramanlu E, Tavallaie S, Mirhosseini N, Taherpour M, Saber H, et al. Serum zinc and copper concentrations in patients with Beta-thalassemia major. Trace Elem Electrolytes. 2013;30: 108–13.
15. Robbiyah N, Deliana M, Mayasari S. Gangguan pertumbuhan sebagai komplikasi talasemia mayor. Majalah Kedokteran Nusantara. 2014; 47: 44–50.
16. Tridjaja B. Short stature (perawakan pendek) diagnosis dan tatalaksana. In: Trihono PP, Djer MM, Sjakti HA (eds) Best Practices in Pediatrics. Jakarta: BP IDAI: 2013. p. 11–8.
17. Arijanty L, Nasar SS. Masalah nutrisi pada thalassemia. Sari Pediatr. 2003; 5: 21–6.
18. Arcasoy A, Çavdar A, Cin, Erten J, Babacan E, Gözdasoglu S, et al. Effects of zinc supplementation on linear growth in beta?thalassemia (A new approach). Am J Hematol. 1987; 24: 127–36.
19. Mehdizadeh M, Zamani G, Tabatabaee S. Zinc status in patients with major ?-thalassemia. Pediatr Hematol Oncol. 2008; 25: 49–54.
20. Arijanty L, Nasar SS, Madiyono B, Gatot D. Relationships between plasma zinc and ferritin with nutritional status in thalassemic children. Paediatr Indones. 2016; 46: 220–4.
21. Eshghi P, Alavi S, Ghavami S, Rashidi A. Growth impairment in beta-thalassemia major: the role of trace element deficiency and other potential factors. J Pediatr Hematol Oncol. 2007; 29: 5–8.
22. Faranoush M, Rahiminejad MS, Karamizadeh Z, Ghorbani R, Owji SM. Zinc supplementation effect linear growth in transfusion dependent ß thalassemia. IJBC. 2008;1:29- 32.
23. Hess SY, Peerson JM, King JC. Use of serum zinc concentration as an indicator of population zinc status. Food Nutr Bull. 2007;28:S403-29.
24. Morshed A, Islam S, Chowdhury T, Islam A, Islam A, Begum H, et al. Serum zink status in patients with haemoglobin-E B-thalassemia. J Dhaka Med Coll. 2013; 22: 115–9.
25. Kwan, E Y, A C. Lee, A M Li. A cross sectional study of growth, puberty and endocrine function in thalassemia major in Hongkong. J Paediatr. 1995; 31: 83-7.
26. Mehdizadeh M, Zamani G, Tabatabaee S. Zinc status in patients with major ?-thalassemia. Pediatr Hematol Oncol. 2008; 25: 49–54.
27. Mansi K, Aburjai T, Barqawi M, Naser H. Copper and zinc status in Jordanian patients with a thalassemia major treated with deferoxamine. Res J Biol Sci. 2009;4: 566–72.
28. Kajanachumpol S, Tatu T, Sasanakul W, Chuansumrit A, Hathirat P. Zinc and copper status of thalassemic children. Southeast Asian J Trop Med Public Heal. 1997; 28: 877–80.
29. Al-Sayer H, Dashti H, Christenson J, Abu-Lisan M, Mada JP, Jeppson B, et al. The role of superoxide dismutase and allupurinal in the prevention of CCl4 induced liver cirrhosis. In: Abdulla M, Dahsti H, Sarkar B, Al-Sayer H, Al Naqeeb N, editors. Metabolism of minerals and trace elements in human disease. Cambridgeshire: Smith Gordon and Company Ltd; 1989. p.65-70.
30. Erdo?an E, Canatan D, Örmeci 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.
31. Bekheirnia MR, Shamshirsaz AA, Kamgar M, Bouzari N, Erfanzadeh G, Pourzahedgilani N, et al. Serum zinc and its relation to bone mineral density in beta-thalassemic adolescents. Biol Trace Elem Res. 2004; 27: 215–24.
32. Mahyar A, Ayazi P, Pahlevan A-A, Mojabi H, Sehhat M-R, Javadi A. Zinc and copper status in children with Beta-thalassemia major. Iran J Pediatr. 2010; 20: 297–302.
33. El Missiry M, Hamed Hussein M, Khalid S, Yaqub N, Khan S, Itrat F, et al. Assessment of serum zinc levels of patients with thalassemia compared to their siblings. Anemia. 2014;2014: 11–6.