Cellular, Molecular and Biomedical Reports

Biosafety Society of Iran

Current Issue

By Issue

By Author

By Subject

Author Index

Keyword Index

About Journal

Aims and Scope

Publication Ethics and Malpractice Statement

Ethical Oversight

Open Access Policy, and Assignment - CC BY

Repository policy

Publisher’S Note

Informed Consent

Guiding Principles for Research Involving Animals and Human Beings

Compliance with Ethical Standards

Copyright and license

CrossMark Policy

Journal Metrics

FAQ

News

Related Links

Responsibility of the Editor

Editorial Policies (Appeals and Complaints)

Guidelines for Guest Editors

Web of Science Profile (for Editing)

Reviewers

Responsibility of Reviewers

Peer Review Process

Peer Review Policy

Web of Science Profile (for reviewing)

Instructions for Authors

Responsibility of the Author

Plagiarism and Similarity Rates

Responding to Allegations of Possible Misconduct

Responses to Possible Misconduct

Permanency of Articles

Data Sharing Policy

Data Citation

Article Processing Charges and Publication Fee

Authors Benefits

Practical Guide to the SI Units

Evaluation of the level of liver enzymes and its relationship with ferritin and the frequency of blood transfusion in patients with thalassemia

Document Type : Original Article

Authors

1 Forensic Medicine and Toxicology, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran

2 Department of Pediatrics, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran

3 Student Research Committee, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran

Abstract

Thalassemia major is the most common hemolytic anemia in Iran and the world that causes an increase in complications in patients, one of the most important of which is liver complications. Therefore, this study aimed to evaluate the level of liver enzymes and their relationship with ferritin and the frequency of blood transfusions in patients with thalassemia. This study was performed on 73 patients with thalassemia major. Demographic, clinical and laboratory information were recorded from the medical files. Data were analysed using SPSS version 22 software. Our study showed significant increasing trend in the AST, ALT and ALP levels in thalassemic patients. However, these changes were not statistically significant amount patients with different frequencies of blood transfusion (p>0.05). Among liver enzymes, just AST and ALT had significant correlations with serum ferritin (p<0.001). In addition, serum ferritin levels of more than 1625 mg/dl could predict the abnormal liver enzymes with the highest sensitivity (59%) and specificity (100%) when considering ALT and AST levels as diagnostic measures for liver problems. Due to the high prevalence of liver damage in thalassemia patients, serum ferritin in combination with the other factors can be applied as a suitable index for assessment of the liver function.

Graphical Abstract

Evaluation of the level of liver enzymes and its relationship with ferritin and the frequency of blood transfusion in patients with thalassemia

Keywords

Main Subjects

Full Text

Selected author of this article by journal

Dr. Pouya Ostadrahimi
Zabol University of Medical Sciences

Google Scholar

Open Access

This article is licensed under a CC BY License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit: http://creativecommons.org/licenses/by/4.0/

 

Publisher’s Note

CMBR journal remains neutral with regard to jurisdictional claims in published maps and institutional afflictions.

 

Letters to Editor

Given that CMBR Journal's policy in accepting articles will be strict and will do its best to ensure that in addition to having the highest quality published articles, the published articles should have the least similarity (maximum 15%). Also, all the figures and tables in the article must be original and the copyright permission of images must be prepared by authors. However, some articles may have flaws and have passed the journal filter, which dear authors may find fault with. Therefore, the editor of the journal asks the authors, if they see an error in the published articles of the journal, to email the article information along with the documents to the journal office.

CMBR Journal welcomes letters to the editor ([email protected], [email protected]) for the post-publication discussions and corrections which allows debate post publication on its site, through the Letters to Editor. Critical letters can be sent to the journal editor as soon as the article is online. Following points are to be considering before sending the letters (comments) to the editor.

[1] Letters that include statements of statistics, facts, research, or theories should include appropriate references, although more than three are discouraged.

[2] Letters that are personal attacks on an author rather than thoughtful criticism of the author’s ideas will not be considered for publication.

[3] There is no limit to the number of words in a letter.

[4] Letter writers should include a statement at the beginning of the letter stating that it is being submitted either for publication or not.

[5] Anonymous letters will not be considered.

[6] Letter writers must include Name, Email Address, Affiliation, mobile phone number, and Comments.

[7] Letters will be answered as soon as possible.

References
  1. Adnan Khalaf M, Hasan ABQ, Qassim Mohammed H, Hussein Ewaid S (2022) Alpha-Hemoglobin Stabilizing Protein Gene Polymorphism (rs4499252 A/G) and its Association with Beta-Thalassemia Major in Iraqi Patients. Arch Razi Inst 77 (3): 1033-1039. doi: https://doi.org/10.22092/ari.2022.357268.2007
  2. Omar A, Gendy W, Marzouk I, Wagdy M (2005) Molecular basis of beta-thalassemia in Alexandria. The Egyptian Journal of Immunology 12 (1): 15-24. doi: https://pubmed.ncbi.nlm.nih.gov/16734135/
  3. Lama R, Yusof W, Shrestha TR, Hanafi S, Bhattarai M, Hassan R, Zilfalil BA (2022) Prevalence and Distribution of Major beta-Thalassemia Mutations and HbE/beta-Thalassemia Variant in Nepalese Ethnic Groups. Hematology/oncology and stem cell therapy 15 (1): 279-284. doi: https://doi.org/10.1016/j.hemonc.2021.01.004
  4. Hatzimichael E, Timotheatou D, Koumpis E, Benetatos L, Makis A (2022) Luspatercept: A New Tool for the Treatment of Anemia Related to beta-Thalassemia, Myelodysplastic Syndromes and Primary Myelofibrosis. Diseases 10 (4). doi: https://doi.org/10.3390/diseases10040085
  5. Lee JS, Rhee TM, Jeon K, Cho Y, Lee SW, Han KD, Seong MW, Park SS, Lee YK (2022) Epidemiologic Trends of Thalassemia, 2006-2018: A Nationwide Population-Based Study. J Clin Med 11 (9). doi: https://doi.org/10.3390/jcm11092289
  6. Piga A, Longo F, Gamberini MR, Voskaridou E, Ricchi P, Caruso V, Pietrangelo A, Zhang X, Shetty JK, Attie KM, Tartaglione I (2022) Long-term safety and erythroid response with luspatercept treatment in patients with beta-thalassemia. Therapeutic advances in hematology 13: 20406207221134404. doi: https://doi.org/10.1177/20406207221134404
  7. Amid A, Saliba AN, Taher AT, Klaassen RJ (2015) Thalassaemia in children: from quality of care to quality of life. Archives of disease in childhood 100 (11): 1051-1057. doi: http://dx.doi.org/10.1136/archdischild-2014-308112
  8. Modell B, Darlison M (2008) Global epidemiology of haemoglobin disorders and derived service indicators. Bulletin of the World Health Organization 86 (6): 480-487.
  9. Kuesap J, Chaijaroenkul W, Rungsihirunrat K, Pongjantharasatien K, Na-Bangchang K (2015) Coexistence of malaria and thalassemia in malaria endemic areas of Thailand. The Korean journal of parasitology 53 (3): 265. doi: https://doi.org/10.3347%2Fkjp.2015.53.3.265
  10. Kohgo Y, Ikuta K, Ohtake T, Torimoto Y, Kato J (2008) Body iron metabolism and pathophysiology of iron overload. International journal of hematology 88: 7-15. doi: https://doi.org/10.1007/s12185-008-0120-5
  11. Olthof AW, Sijens PE, Kreeftenberg HG, Kappert P, Irwan R, van der Jagt EJ, Oudkerk M (2007) Correlation between serum ferritin levels and liver iron concentration determined by MR imaging: impact of hematologic disease and inflammation. Magnetic Resonance Imaging 25 (2): 228-231. doi: https://doi.org/10.1016/j.mri.2006.09.019
  12. Pakbaz Z, Fischer R, Fung E, Nielsen P, Harmatz P, Vichinsky E (2007) Serum ferritin underestimates liver iron concentration in transfusion independent thalassemia patients as compared to regularly transfused thalassemia and sickle cell patients. Pediatric blood & cancer 49 (3): 329-332. doi: https://doi.org/10.1002/pbc.21275
  13. El-Gamal RAE-R, Abdel-Messih IY, Habashy DM, Zaiema SEG, Pessar SA (2020) Erythroferrone, the new iron regulator: evaluation of its levels in Egyptian patients with beta thalassemia. Annals of Hematology 99: 31-39. doi: https://doi.org/10.1007/s00277-019-03882-w
  14. Graham RM, Reutens GM, Herbison CE, Delima RD, Chua ACG, Olynyk JK, Trinder D (2008) Transferrin receptor 2 mediates uptake of transferrin-bound and non-transferrin-bound iron. Journal of Hepatology 48 (2): 327-334. doi: https://doi.org/10.1016/j.jhep.2007.10.009
  15. Levi S, Yewdall SJ, Harrison P, Santambrogio P, Cozzi A, Rovida E, Albertini A, Arosio P (1992) Evidence of H-and L-chains have co-operative roles in the iron-uptake mechanism of human ferritin. Biochemical Journal 288 (2): 591-596. doi: https://doi.org/10.1042/bj2880591
  16. Naz N, Moriconi F, Ahmad S, Amanzada A, Khan S, Mihm S, Ramadori G, Malik IA (2013) Ferritin L is the sole serum ferritin constituent and a positive hepatic acute-phase protein. Shock 39 (6): 520-526. doi: https://doi.org/10.1097/SHK.0b013e31829266b9
  17. Sammarco MC, Ditch S, Banerjee A, Grabczyk E (2008) Ferritin L and H subunits are differentially regulated on a post-transcriptional level. Journal of Biological Chemistry 283 (8): 4578-4587. doi: https://doi.org/10.1074/jbc.M703456200
  18. Malik IA, Wilting J, Ramadori G, Naz N (2017) Reabsorption of iron into acutely damaged rat liver: A role for ferritins. World Journal of Gastroenterology 23 (41): 7347. doi: https://doi.org/10.3748%2Fwjg.v23.i41.7347
  19. Al-Momen H, Jasim SK, Hassan QA, Ali HH (2018) Relationship between liver iron concentration determined by R2-MRI, serum ferritin, and liver enzymes in patients with thalassemia intermedia. Blood research 53 (4): 314-319. doi: https://doi.org/10.5045/br.2018.53.4.314
  20. Chen N, Kassir N, Laadem A, Giuseppi AC, Shetty J, Maxwell SE, Sriraman P, Ritland S, Linde PG, Budda B, Reynolds JG, Zhou S, Palmisano M (2021) Population Pharmacokinetics and Exposure-Response Relationship of Luspatercept, an Erythroid Maturation Agent, in Anemic Patients With beta-Thalassemia. Journal of clinical pharmacology 61 (1): 52-63. doi: https://doi.org/10.1002/jcph.1696
  21. Elbedewy TA, Abd-Elsalam S, Mostafa SM, Abdellatif RS, Fouad A, Youssef M, Abo-Amer YE, Elsebaey MA (2022) Sofosbuvir/Ledipasvir for Treatment of Chronic Hepatitis C Infection in Adult Patients with beta- Thalassemia Major: A Real-Life Study. Endocrine, metabolic & immune disorders drug targets 22 (3): 290-296. doi: https://doi.org/10.2174/1871530321666210202150538
  22. Susanah S, Idjradinata PS, Sari NM, Rakhmilla LE, Sribudiani Y, Trisaputra JO, Moestopo O (2020) Time to Start Delivering Iron Chelation Therapy in Newly Diagnosed Severe beta-Thalassemia. Biomed Res Int 2020: 8185016. doi: https://doi.org/10.1155/2020/8185016
  23. Xiao F, Qiu XF, You CW, Xie FP, Cai YY (2023) Influence of liver function after laparoscopy-assisted vs totally laparoscopic gastrectomy. World J Gastrointest Surg 15 (5): 859-870. doi: https://doi.org/10.4240/wjgs.v15.i5.859
  24. Salama KM, Ibrahim OM, Kaddah AM, Boseila S, Ismail LA, Hamid MMA (2015) Liver enzymes in children with beta-thalassemia major: correlation with iron overload and viral hepatitis. Open access Macedonian journal of medical sciences 3 (2): 287. doi: https://doi.org/10.3889%2Foamjms.2015.059
  25. Khadivi Heris H, Nejati B, Rezazadeh K, Sate H, Dolatkhah R, Ghoreishi Z, Esfahani A (2021) Evaluation of iron overload by cardiac and liver T2* in beta-thalassemia: Correlation with serum ferritin, heart function and liver enzymes. Journal of cardiovascular and thoracic research 13 (1): 54-60. doi: https://doi.org/10.34172/jcvtr.2021.18
  26. Origa R, Cinus M, Pilia MP, Gianesin B, Zappu A, Orecchia V, Clemente MG, Pitturru C, Denotti AR, Corongiu F, Piras S, Barella S (2022) Safety and Efficacy of the New Combination Iron Chelation Regimens in Patients with Transfusion-Dependent Thalassemia and Severe Iron Overload. J Clin Med 11 (7): 22-36. doi: https://doi.org/10.3390/jcm11072010
  27. Susanah S, Rakhmilla LE, Ghozali M, Trisaputra JO, Moestopo O, Sribudiani Y, Idjradinata PS, Maskoen AM (2021) Iron Status in Newly Diagnosed beta-Thalassemia Major: High Rate of Iron Status due to Erythropoiesis Drive. Biomed Res Int 2021: 5560319. doi: https://doi.org/10.1155/2021/5560319
  28. Hosen MB, Karmokar NC, Karim MF, Al Mahmud R, Mesbah M (2015) Association of AST, ALT, ALB and Total Protein with Beta-thalassemia in Bangladeshi Population. International Journal 3 (1): 991-995. doi:
  29. Aldwaik R, Abu Mohor T, Idyabi I, Warasna S, Abdeen S, Karmi B, Abu Seir R (2021) Health Status of Patients With beta-Thalassemia in the West Bank: A Retrospective-Cohort Study. Front Med (Lausanne) 8: 788758. doi: https://doi.org/10.3389/fmed.2021.788758
  30. Takhviji V, Zibara K, Azarkeivan A, Mehrvar N, Mehrvar N, Mezginejad F, Khosravi A (2020) Fertility and pregnancy in Iranian thalassemia patients: An update on transfusion complications. Transfusion medicine (Oxford, England) 30 (5): 352-360. doi: https://doi.org/10.1111/tme.12707
  31. Yehia A, Sousa RAL, Abulseoud OA (2023) Sex difference in the association between blood alcohol concentration and serum ferritin. Front Psychiatry 14: 1230406. doi: https://doi.org/10.3389/fpsyt.2023.1230406
  32. Papastamataki M, Delaporta P, Premetis E, Kattamis A, Ladis V, Papassotiriou I (2010) Evaluation of liver fibrosis in patients with thalassemia: the important role of hyaluronic acid. Blood Cells, Molecules, and Diseases 45 (3): 215-218. doi: https://doi.org/10.1016/j.bcmd.2010.06.002
  33. Fraquelli M, Cassinerio E, Roghi A, Rigamonti C, Casazza G, Colombo M, Massironi S, Conte D, Cappellini MD (2010) Transient elastography in the assessment of liver fibrosis in adult thalassemia patients. American journal of hematology 85 (8): 564-568. doi: https://doi.org/10.1002/ajh.21752
  34. Pietrangelo A (2016) Mechanisms of iron hepatotoxicity. Journal of hepatology 65 (1): 226-227. doi: https://doi.org/10.1016/j.jhep.2016.01.037
  35. Britton RS, Leicester KL, Bacon BR (2002) Iron toxicity and chelation therapy. International journal of hematology 76: 219-228. doi: https://doi.org/10.1007/BF02982791
  36. Taher A, El Rassi F, Isma’eel H, Koussa S, Inati A, Cappellini MD (2008) Correlation of liver iron concentration determined by R2 magnetic resonance imaging with serum ferritin in patients with thalassemia intermedia. Haematologica 93 (10): 1584-1586. doi: https://doi.org/10.3324/haematol.13098
  37. Cai C, Hu W, Chu T (2021) Interplay Between Iron Overload and Osteoarthritis: Clinical Significance and Cellular Mechanisms. Front Cell Dev Biol 9: 817104. doi: https://doi.org/10.3389/fcell.2021.817104
  38. Shah R, Shah A, Badawy SM (2023) An evaluation of deferiprone as twice-a-day tablets or in combination therapy for the treatment of transfusional iron overload in thalassemia syndromes. Expert review of hematology 16 (2): 81-94. doi: https://doi.org/10.1080/17474086.2023.2178409
  39. Xu G, Li X, Zhu Z, Wang H, Bai X (2021) Iron Overload Induces Apoptosis and Cytoprotective Autophagy Regulated by ROS Generation in Mc3t3-E1 Cells. Biological trace element research 199 (10): 3781-3792. doi: https://doi.org/10.1007/s12011-020-02508-x
  40. Al-Mashdali A, Alyafei T, Yassin M (2021) The Superiority of T2*MRI Over Serum Ferritin in the Evaluation of Secondary Iron Overload in a Chronic Kidney Disease Patient: A Case Report. J Blood Med 12: 665-670. doi: https://doi.org/10.2147/jbm.s319591
  41. Sun M, Gan J, Li Y, Dai S, Lv C, Zhao G (2022) Fabrication of a donkey spleen ferritin-pectin complex to reduce iron release and enhance the iron supplementation efficacy. Food Funct 13 (16): 8500-8508. doi: https://doi.org/10.1039/d2fo01338j
  42. Tiwari R, Saharia GK, Mangaraj M (2021) Evaluation of Serum Ferritin and Anti-Thyroid Peroxidase Antibody Status in Newly Diagnosed Subclinical Cases of Hypothyroidism. Endocrine, metabolic & immune disorders drug targets 21 (8): 1453-1458. doi: https://doi.org/10.2174/1871530320666200925125404
  43. De A, Samaddar D, Sen A, Sen PK (2019) Comparative assessment of serum liver enzymes (AST and ALT) in thalassemia patients of Murshidabad and matched controls. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) 17 (11): 01-05.
  44. Weatherall DJ (2012) The definition and epidemiology of non-transfusion-dependent thalassemia. Blood reviews 26: S3-S6. doi: https://doi.org/10.1016/s0268-960x(12)70003-6
  45. Sengsuk C, Tangvarasittichai O, Chantanaskulwong P, Pimanprom A, Wantaneeyawong S, Choowet A, Tangvarasittichai S (2014) Association of iron overload with oxidative stress, hepatic damage and dyslipidemia in transfusion-dependent β-thalassemia/HbE patients. Indian Journal of Clinical Biochemistry 29: 298-305. doi: https://doi.org/10.1007/s12291-013-0376-2
  46. Viprakasit V, Tyan P, Rodmai S, Taher AT (2014) Identification and key management of non-transfusion-dependent thalassaemia patients: not a rare but potentially under-recognised condition. Orphanet journal of rare diseases 9: 1-11. doi: https://doi.org/10.1186/s13023-014-0131-7
  47. Maharani EA, Soedarmono YS, Nainggolan IM (2014) Frequency of thalassemia carrier and Hb variant and the quality of stored donor blood. Medical Journal of Indonesia 23 (4): 209-212. doi: https://doi.org/10.13181/mji.v23i4.766
  48. Rivella S (2012) The role of ineffective erythropoiesis in non-transfusion-dependent thalassemia. Blood reviews 26: S12-S15. doi: https://doi.org/10.1016/s0268-960x(12)70005-x
  49. Batts KP (2007) Iron overload syndromes and the liver. Modern Pathology 20 (1): S31-S39. doi: https://doi.org/10.1038/modpathol.3800715
  50. Shah R, Trehan A, Das R, Marwaha R (2014) Serum ferritin in thalassemia intermedia. Indian Journal of Hematology and Blood Transfusion 30: 281-285. doi: https://doi.org/10.1007/s12288-013-0267-y
Cellular, Molecular and Biomedical Reports
Volume 4, Issue 2
Cellular, Molecular and Biomedical Reports (Online ISSN: 2823-2550)
June 2024
Pages 100-110
Files
History
  • Receive Date: 05 June 2023
  • Revise Date: 14 August 2023
  • Accept Date: 28 September 2023
Share
How to cite
Statistics