CORRELATION OF SERUM FERRITIN WITH HAEMOGLOBIN A2 LEVEL IN BETA THALASSEMIA TRAITS

Mehreen Hameed, Fazle Raziq, Awal Mir

Abstract


Background: Haemoglobin-A2 is considered as a paramount diagnostic parameter for the detection of beta-thalassemia trait which may vary with the fluctuation of body iron stores. The current study aims to evaluate the correlation of serum ferritin as a parameter of body iron stores with haemoglobin-A2 level in beta-thalassemia traits. Methods: This cross-sectional study was conducted on total 134 known beta-thalassemia traits in Rehman Medical Institute-Peshawar, Pakistan from October 2018 to June 2019. Blood samples from the contributors were drawn in EDTA and plain tubes for complete blood counts, haemoglobin-A2 and serum ferritin estimation. Participants were categorized into 3 groups on the basis of iron status; beta-thalassemia traits with low ferritin (Group A), normal ferritin (Group B) and high ferritin levels (Group C). Pearson correlation was applied to analyse the correlation between the variables. Results: Out of total 134 known beta-thalassemia traits, 73 (54.5 %) were males and 61 (45.5%) were females. Participants of group A with low ferritin were 22 (16.4%), group B with normal ferritin were 96 (71.6%) and group C with high ferritin were 16 (11.9%). Group A shows lowest mean haemoglobin-A2 level comparatively to Group B and Group C, with some effect of serum ferritin on haemoglobin-A2 level. Conclusion: Haemoglobin-A2 value decreases when there is a decrease in serum ferritin and show slightly increase with high ferritin level as compared to normal ferritin level or body iron stores in beta-thalassemia traits. However, this correlation is not significant enough to mask the actual diagnosis of the disease.

Keywords: Beta Thalassemia Trait; Haemoglobin A2 level; Serum Ferritin


References


Brand S, Ahmadpanah M, Asadi Y, Haghighi M, Ghasemibasir H, Khanlarzadeh E. In patients with minor beta-thalassemia, cognitive performance is related to length of education, but not to minor beta-thalassemia or hemoglobin levels. Iran J Psychiatry 2019;14(1):47–53.

Bhalodia JN, Oza HV, Modi PJ, Shah AM, Patel KA, Patel HB. Study of hemoglobinopathies in patients of anemia using high performance liquid chromatography (HPLC) in Western India. Natl J Community Med 2015;6(1):35–40.

Qazi RA, Shams R, Hassan H, Asif N. Screening for Beta Thalassemia Trait. J Rawal Med Coll 2014;18(1):158–60.

Asif N, Hassan K. Prevention of beta thalassemia in Pakistan. J Islam Med Dent Coll 2014;3(2):46–7.

Ahmed MM, Salaria SM, Qamar S, Soaz MA, Bukhari MH, Qureshi AH. Incidence of β-thalassemia carriers in Muzaffarabad, Azad Kashmir. Ann Punjab Med Coll 2016;10(1):11–9.

Sa'ad Allah IAA. Prevalence of β-Thalassemia Carriers among a high Health Institute Students in Sana'a, Yemen (2013-2016) (Doctoral dissertation, University of Gezira), 2016.

Al-Amodi AM, Ghanem NZ, Aldakeel SA, Ibrahim Al Asoom L, RafiqueAhmed N, Almandil NB, et al. Hemoglobin A2 (HbA2) has a measure of unreliability in diagnosing β-thalassemia trait (β-TT). Curr Med Res Opin 2018;34(5):945–51.

Taher AT, Weatherall DJ, Cappellini MD. Thalassaemia. Lancet 2018;391(10116):155–67.

Mosca A, Paleari R, Ivaldi G, Glalnello R, Giordano PC. The role of haemoglobin A2 testingin the diagnosis of thalassaemias and related haemoglobinopathies. J Clin Pathol 2009;62(1):13–7.

Al-Jafar H, Bahzad S, Al-Awadhi AM, Al Nahham M, Pagaa MR. The Impact of Repeated Hb A2 Measurements on β-Thalassemia Trait Diagnosis. J Hematol Blood Disord 2016;2(2):204.

Perseu L, Satta S, Moi P, Demartis FR, Manunza L, Sollaino MC, et al. KLF1 gene mutations cause borderline HbA2. Blood 2011;118(16):4454–8.

Moghaddam ZK, Bayat N, Valaei A, Kordafshari A, Zarbakhsh B, Zainali S, et al. Coinheritance of a- and b-thalassemia: challenges in prenatal diagnosis of thalassemia. Iran J Blood Cancer 2012;2:81–4.

Rosnah B, Shahida NS, Nazri MH, Marini R, Noor Haslina MN. The Diagnosis of Beta Thalassemia with Borderline HbA2 Level among Kelantan Population. J Blood Disord Transfus 2017;8(396):2.

Leecharoenkiat K, Lithanatudom P, Sornjai W, Smith DR. Iron dysregulation in beta-thalassemia. Asian Pac J Trop Med 2016;9(11):1035–43.

Winter WE, Bazydlo LA, Harris NS. The molecular biology of human iron metabolism. Lab Med 2014;45(2):92–102.

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. Clin Lab Haematol 2002;24(5):285–9.

Denic S, Agarwal MM, Al Dabbagh B, El Essa A, Takala M, Showqi S, et al. Hemoglobin A2 Lowered by Iron Deficiency and α-Thalassemia: Should Screening Recommendation for β-Thalassemia Change? ISRN Hematology 2013;2013:858294.

Khan AA, Quigley JG. Control of intracellular heme levels: heme transporters and heme oxygenases. Biochim Biophys Acta BBA-Mol Cell Res 2011;1813(5):668–82.

Barrett AN, Saminathan R, Choolani M. Thalassaemia screening and confirmation of carriers in parents. Best Pract Res Clin Obstet Gynaecol 2017;39:27–40.

Saraya AK, Kumar R, Choudhry VP, Kailash S, Sehgal AK. A study of serum ferritin in beta thalassemia: iron deficiency and overload. Am J Clin Pathol 1985;84(1):103–7.

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 Hematology 2014;2014:293216.

Usman M, Moinuddin M, Ahmed SA. Role of iron deficiency anemia in the propagation of beta thalssemia gene. Korean J Hematol 2011;46(1):41–4.

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(3):472–3.

Sharma P, Das R, Trehan A, Bansal D, Chhabra S, Kaur J, et al. Impact of iron deficiency on hemoglobin A2% in obligate β‐thalassemia heterozygotes. Int J Lab Hematol 2015;37(1):105–11.

Kamal AA, Jalal SD, Mohammed DJ. The Impact of Iron Deficiency on HBA2 Level in Beta Thalassemia Minor in Sulaimani Northeastern Iraq. 2015.

Yavarian M, Cohan N, Mazarehi H, Roshannia M, Dehbozorgian J, Amirghofran S, et al. Impact of Iron Deficiency Anemia on HbA2 levels. J Appl Hematol 2011;2011:200–2.


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]