The association between iron over load and tanner stage retardation in the females with B-thalassemia major in Thalassemia center of Diwaniyah maternity and children teaching Hospital.

Abstract

Despite optimal therapy of patients with B- thalassemia major included regular blood transfusion program and iron chalation agents helped by increasing survival of these patients but remained major problem in adolescent of these patients such as growth failure and hypogonadisim.               

 Aim of study: To determine the association between iron over load and tanner stage retardation among female patients with B- thalassemia major in Thalassemia center of Diwaniyah maternity and children teaching Hospital.

Methods: The current study was carried out on all  female patients diagnosed ?-thalassemia major on the base of the blood investigations (peripheral blood counts and hemoglobin electrophoresis),with their age range from 13years to 16 years who registered in Thalassemia center of Diwaniyah maternity and children teaching hospital in Al- Diwaniyah  Governorate, Republic of Iraq. The Data collection was carried out during the period from the 1^st of April of 2016 to 30th of December of 2016. They were studied for determining the association between iron over load and tanner stage retardation among female  patients with B- thalassemia major.

     The following data were collected from the patients:

       Name, age, address ,age of diagnosis of thalassemia, number of blood transfusion per year, types of chelating agent.

     In the physical examination, the patients were assessed for weight, height, Tanner stages and body mass index(BMI) which recorded.

1. Ferritin value was used to assess iron load, pelvic ultrasound was checked to assess the size of uterus and both ovaries.

    Results: Total numbers of B- thalassemia major female patients are 31 patient, aged 13-16 years (mean age: 14.13 ±1.20) . Age of patients at time of diagnosis of B- thalassemia major range from 0.17 to 5 year with Mean ± SD(1.40 ±1.30). Frequency of Blood transfusion (time/Year) range from 6 to 33 time/Year with Mean ± SD(16.68 ±4.98). Level of serum ferritin of the patients was ranged from 913-12000 ng/ml with Mean ± SD (4963.60 ±3580.39).

  Tanner stage I was predominant accounting for 87% whereas stage II and III accounted for 10% and 3% respectively. There was no significant correlation between Tanner stage and age of patient and also no significant correlation with age at time of diagnosis (P>0.05). There was a significant negative correlation between frequency of blood transfusion and Tanner (r=-0.385, P= 0.045), so that the higher the frequency of transfusion, the lower the tanner stage is. No correlation was found between the dose of chelating agent and Tanner stage (P=0.599). Height and weight of patients were significantly correlated with Tanner stage (P=0.028 and P=0.007, respectively). No significant correlation was found between serum ferritin and Tanner stage (P=0.444). There was a significant correlation between Uterus size, ovarian size and Tanner stage (P=0.007and P=0.007, respectively).

Conclusion: These results showed that no significant correlation between tanner stages retardation and iron overload in female patients with ?-thalassemia major measured by serum ferritin. Because of inflammation falsely increase serum ferritin or because of the relationship between body iron and level of serum ferritin is not always within the linear range especially in condition of inflammation or tissue damage. So that serum ferritin level is not a reliable indicator of total body iron stores in patients with thalassemia major, therefore; we needed  another indicator to measure total body iron stores in patients with thalassemia major such as the liver iron concentration.