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Effect of iron therapy on red cell indices and hemoglobin subtypes on patients with beta-thalassemia trait who developed iron-deficiency anemia: a tertiary center experience

The Egyptian Journal of Internal Medicine volume 31, pages 741–745 (2019)Cite this article

Abstract

Background

The combination of beta-thalassemia trait (BTT) and iron-deficiency anemia (IDA) is an interesting common issue in our country. However, treatment of this condition is challenging.

Objectives

This prospective observational study was designed to evaluate the effect of oral iron therapy on red cell indices, iron status, and hemoglobin A2 levels in patients with BTT who developed IDA.

Patients and methods

A total of 50 patients with BTT who developed IDA were included. A complete blood count, iron status, and follow-up hemoglobin electrophoresis by high-performance liquid chromatography were done. The patients with BTT received oral iron therapy of 60mg elemental iron three times/day for a period of 5 months, and the investigations were repeated after 3 and 5 months of treatment.

Results

There was a statistically significant increase in hemoglobin level (P<0.001 each), mean corpuscular volume (P<0.001 each), mean corpuscular hemoglobin (P=0.004 and P<0.001, respectively), mean corpuscular hemoglobin concentration (P=0.007 and P=0.001, respectively), serum iron (P<0.001 each), serum ferritin (P<0.001 each), and hemoglobin A2 levels (P=0.001 and P=0.005, respectively), whereas significant decrease in the total iron-binding capacity (P=0.001, and P=0.005, respectively) after the third and fifth month of oral iron therapy.

Conclusion

It is important to suspect, recognize, and correct IDA in patients with BTT and to repeat hemoglobin electrophoresis after iron therapy.

References

  1. Dolai TK, Nataraj K, Sinha N, Mishra S, Bhattacharya M, Ghosh MK. Prevalance of iron deficiency in thalassemia minor: a study from tertiary hospital. Indian J Hematol Blood Transf 2012; 28:7–9.

    Article  Google Scholar 

  2. Karim MUA, Moinuddin M, Babar SU. Cap+ 1 mutation; an unsuspected cause of beta thalassaemia transmission in Pakistan. Turk J Haematol 2009; 26:167.

    PubMed  Google Scholar 

  3. Bencaiova G, Burkhardt T, Krafft A, Zimmermann R. Screening for β-thalassaemia trait in anaemic pregnant women. Gynecol Obstetr Investig 2006; 62:20–27.

    Article  CAS  Google Scholar 

  4. Amani MA, Neda G, Sumayh A, Francis JB. Hemoglobin A 2 (HbA 2) has a measure of unreliability in diagnosing β-thalassemia trait (β-TT). Curr Med Res Opin 2018; 34:1–16.

    Google Scholar 

  5. Giambona A, Passarello C, Renda D, Maggio A. The significance of the hemoglobin A(2) value in screening for hemoglobinopathies. Clin Biochem 2009; 42:1786–1796.

    Article  CAS  Google Scholar 

  6. Harthoorn-Lasthuizen E, Lindemans J, Langenhuijsen MC. Influence of iron deficiency anaemia on haemoglobin A2 levels: possible consequences for ß thalassaemia screening. Scand J Clin Lab Investig 1999; 59:65–70.

    Article  CAS  Google Scholar 

  7. El-Agouza I, Abu Shahla A, Sirdah M. The effect of iron deficiency anaemia on the levels of haemoglobin subtypes: possible consequences for clinical diagnosis. Int J Lab Hematol 2002; 24:285–289.

    CAS  Google Scholar 

  8. Keramati MR, Maybodi NT. The effect of iron deficiency anemia (IDA) on the HbA2 level and comparison of hematologic values between IDA and thalassemia minor. Int J Hematol Oncol 2007; 27:151–156.

    Google Scholar 

  9. Madan N, Sikka M, Sharma S, Rusia U. Phenotypic expression of hemoglobin A2 in beta-thalassemia trait with iron deficiency. Ann Hematol 1998; 77:93–96.

    Article  CAS  Google Scholar 

  10. Verma S, Gupta R, Kudesia M, Mathur A, Krishan G, Singh S. Coexisting iron deficiency anemia and Beta thalassemia trait: effect of iron therapy on red cell parameters and hemoglobin subtypes. ISRN Hematol 2014; 2014:293216.

    Article  Google Scholar 

  11. Abdul Hafeez K, Watshara S, Virapong P, Pornlada N. New bioinformatics-based discrimination formulas for differentiation of thalassemia traits from iron deficiency anemia. Lab Med 2017; 48:230–237.

    Article  Google Scholar 

  12. Qureshi TZ, Anwar M, Ahmed S, Khan DA, Saleem M. Serum ferritin levels in carriers of β-thalassaemia trait. Acta Haematol 1995; 94:7–9.

    Article  CAS  Google Scholar 

  13. Niazi M, Tahir M, Raziq F, Hameed A. Usefulness of red cell indices in differentiating microcytic hypochromic anemias. GJMS 2010; 8:125–129.

    Google Scholar 

  14. Jahan T, Ishaq M, Siddiq A. Anemia in pregnant women; prevalence in Ibn-E-Siena Hospital Multan. Prof Med J 2017; 24:5.

    Google Scholar 

  15. Arshad M, Ahmed S, Ali N. Effect of iron deficiency on the phenotype of β thalassaemia trait. J Coll Physicians Surg Pak 2016; 26:230–231.

    PubMed  Google Scholar 

  16. Passarello C, Giambona A, Cannata M, Vinciguerra M, Renda D, Maggio A. Iron deficiency does not compromise the diagnosis of high HbA2 β thalassemia trait. Haematologica 2012; 97:472–473.

    Article  CAS  Google Scholar 

  17. Saraya A, Kumar R, Kailash S, Sehgal A. Iron deficiency in beta-heterozygous thalassaemia. Indian J Med Res 1984; 79:68–75.

    CAS  PubMed  Google Scholar 

  18. Hinchliffe R, Lilleyman J. Frequency of coincident iron deficiency and beta-thalassaemia trait in British Asian children. J Clin Pathol 1995; 48:594–595.

    Article  CAS  Google Scholar 

  19. Mehta B, Pandya B. Iron status of beta thalassemia carriers. Am J Hematol 1987; 24:137–141.

    Article  CAS  Google Scholar 

  20. Hoorfar H, Sadrarhami S, Keshteli AH, Ardestani SK, Ataei M, Moafi A. Evaluation of iron status by serum ferritin level in Iranian carriers of beta thalassemia minor. Int J Vit Nutr Res 2008; 78:204–207.

    Article  CAS  Google Scholar 

  21. Usman M, Moinuddin M, Ahmed SA. Role of iron deficiency anemia in the propagation of beta thalssemia gene. Korean J Hematol 2011; 46:41–44.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, Clinical Hematology Unit, Assiut University, Assiut, 71515, Egypt

    Sawsan M. Moeen MD Clinical Hematology & Ahmad F. Thabet

  2. Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt

    Marwa M. Thabet

Authors
  1. Sawsan M. Moeen MD Clinical Hematology
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  2. Ahmad F. Thabet
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  3. Marwa M. Thabet
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Correspondence to Sawsan M. Moeen MD Clinical Hematology.

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Moeen, S.M., Thabet, A.F. & Thabet, M.M. Effect of iron therapy on red cell indices and hemoglobin subtypes on patients with beta-thalassemia trait who developed iron-deficiency anemia: a tertiary center experience. Egypt J Intern Med 31, 741–745 (2019). https://doi.org/10.4103/ejim.ejim_38_19

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  • DOI: https://doi.org/10.4103/ejim.ejim_38_19

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