A comparative study of 25 hydroxy vitamin D levels in patients of thalassemia and healthy children
Keywords:
Thalassemia major, Calcium, Vitamin D
Abstract
Introduction: Vitamin D deficiency is emerging threat to patients with thalassemia. Adequate circulating levels of vitamin D are essential for optimal skeletal health and reducing fracture risk. The aim of this study was to evaluate the 25-OH- vitamin D levels in patients of thalassemia and compare its prevalence to healthy children.
Methodology: In a case control study, 50 patients with beta thalassemia major (aged from 3 to 18 years) were compared with 50 sex and age matched children serves as a control group. Anthropometric measurement, Serum level of calcium, phosphorus, alkaline phosphatase, parathyroid hormone and 25-OH-vitamin D (25 hydroxycholecalciferol) were estimated for all patients & controls.
Results: 25-OH-vitamin D deficiency was observed in 98% cases and 68% in control group. Difference in mean vitamin D levels between cases and controls was statistically significant (p<0.05). Weight and body mass index were significantly (p<0.05) lower in cases. Patient with beta thalassemia major compare to control had significantly (p<0.05) higher level of alkaline phosphatase and parathyroid hormone level.
Conclusion: Thalassemia is associated with increased prevalence of 25-OH-vitamin D deficiency resulting in poor growth and quality of life in these children. This signifies the importance of therapeutic intervention.
Downloads
Download data is not yet available.
References
1. Kesse-Adu R, Howard J. Inherited anaemias: sickle cell and thalassaemia. Medicine. 2013;41(4):219–24.
2. Higgs DR, Engel JD, Stamatoyannopoulos G. Thalassaemia. Lancet. 2012 Jan 28;379(9813):373-83. doi: 10.1016/S0140-6736(11)60283-3. Epub 2011 Sep 9. [PubMed]
3. Perrotta S, Gallagher PG, Mohandas N. Hereditary spherocytosis. Lancet. 2008 Oct 18;372(9647):1411-26. doi: 10.1016/S0140-6736(08)61588-3. [PubMed]
4. Satwani H, Raza J, Alam M, et al. Endocrine Complications in Thalassemias: Frequency and Association with Serum Ferritin Levels. Pak Paediat Assoc J. 2005;29:113–9.
5. Condamine L, Vztovsnik F, Friedlander G, Menaa C, Garabedian M. Local action of phosphate depletion and insulin-like growth factor–I on in vitro production of 1,25-dihydroxyvitamin D3 by cultured mammalian kidney cells. J Clin Invest. 1994;94:1673–1679.
6. Wright NM, Papadea N, Wentz B, Hollis B, Willi S, Bell NH. Increased serum 1,25-dihydroxyvitamin D after growth hormone administration is not parathyroid hormone-mediated. Calcif Tissue Int. 1997 Aug;61(2):101-3
7. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30. doi: 10.1210/jc.2011-0385. Epub 2011 Jun 6.
8. Mahachoklertwattana P, Sirikulchayanonta V, Chuansumrit A, Karnsombat P, Choubtum L, Sriphrapradang A, Domrongkitchaiporn S, Sirisriro R, Rajatanavin R. Bone histomorphometry in children and adolescents with beta-thalassemia disease: iron-associated focal osteomalacia. J Clin Endocrinol Metab. 2003 Aug;88(8):3966-72. [PubMed]
9. De Sanctis V, Vullo C, Bagni B, Chiccoli L. Hypoparathyroidism in beta-thalassemia major. Clinical and laboratory observations in 24 patients. Acta Haematol. 1992;88(2-3):105-8. [PubMed]
10. Singh K, Kumar R, Shukla A, Phadke SR, Agarwal S. Status of 25-hydroxyvitamin D deficiency and effect of vitamin D receptor gene polymorphisms on bone mineral density in thalassemia patients of North India. Hematology. 2012 Sep;17(5):291-6. doi: 10.1179/1607845412Y.0000000017.
11. Nakavachara P, Viprakasit V. Children with hemoglobin E/β-thalassemia have a high risk of being vitamin D deficient even if they get abundant sun exposure: a study from Thailand. Pediatr Blood Cancer. 2013 Oct;60(10):1683-8. doi: 10.1002/pbc.24614. Epub 2013 Jun 3. [PubMed]
12. Giardina PJ, Forget BG. Thalassemia syndromes. In: Hoffman R, Benz EJ, Shattil SS, et al., editors. Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008. chap 41.
13. Raiola G, Galati MC, De Sanctis V, Caruso Nicoletti M, Pintor C, De Simone M, Arcuri VM, Anastasi S. Growth and puberty in thalassemia major. J Pediatr Endocrinol Metab. 2003 Mar;16 Suppl 2:259-66. [PubMed]
14. Bielinski BK, Darbyshire PJ, Mathers L, Crabtree NJ, Kirk JM, Stirling HF, Shaw NJ. Impact of disordered puberty on bone density in beta-thalassaemia major.Br J Haematol. 2003 Jan;120(2):353-8. [PubMed]
15. Hashemi A, Ghilian R, Golestan M, et al. The study of growth in thalassemic patients and its correlation with serum ferritin level. IJPHO. 2011;1(4):147–51. [PubMed]
16. Jain M, Sinha RS, Chellani H, Anand NK. Assessment of thyroid functions and its role in body growth in thalassemia major. Indian Pediatr. 1995 Feb;32(2):213-9. [PubMed]
17. Shamshirsaz AA, Bekheirnia MR, Kamgar M, Pourzahedgilani N, Bouzari N, Habibzadeh M, Hashemi R, Shamshirsaz AA, Aghakhani S, Homayoun H, Larijani B. Metabolic and endocrinologic complications in beta-thalassemia major: a multicenter study in Tehran. BMC Endocr Disord. 2003 Aug 12;3(1):4. [PubMed]
18. Kassab-Chekir A, Laradi S, Ferchichi S, Haj Khelil A, Feki M, Amri F, Selmi H, Bejaoui M, Miled A. Oxidant, antioxidant status and metabolic data in patients with beta-thalassemia. Clin Chim Acta. 2003 Dec;338(1-2):79-86. [PubMed]
19. Hamed EA, El-Melegy NT. Renal functions in pediatric patients with beta-thalassemia major: relation to chelation therapy: original prospective study. Ital J Pediatr. 2010;36:39. [PubMed]
20. Zamboni G, Marradi P, Tagliaro F, Dorizzi R, Tatò L. Parathyroid hormone, calcitonin and vitamin D metabolites in beta-thalassaemia major. Eur J Pediatr. 1986 Apr;145(1-2):133-6. [PubMed]
21. Aleem A, Al-Momen AK, Al-Harakati MS, Hassan A, Al-Fawaz I. Hypocalcemia due to hypoparathyroidism in beta-thalassemia major patients. Ann Saudi Med. 2000 Sep-Nov;20(5-6):364-6. [PubMed]
22. Vogiatzi MG, Autio KA, Mait JE, Schneider R, Lesser M, Giardina PJ. Low bone mineral density in adolescents with beta-thalassemia. Ann N Y Acad Sci. 2005;1054:462-6. [PubMed]
23. Mahachoklertwattana P, Chuansumrit A, Choubtum L, Sriphrapradang A, Sirisriro R, Rajatanavin R. Bone mineral density in children and young adults with beta-thalassemia trait. J Pediatr Endocrinol Metab. 2002 Nov-Dec;15(9):1531-5. [PubMed]
24. Di Stefano M, Chiabotto P, Roggia C, Garofalo F, Lala R, Piga A, Isaia GC. Bone mass and metabolism in thalassemic children and adolescents treated with different iron-chelating drugs. J Bone Miner Metab. 2004;22(1):53-7. [PubMed]
25. Merchant R, Udani A, Puri V, D'cruz V, Patkar D, Karkera A. Evaluation of osteopathy in thalassemia by bone mineral densitometry and biochemical indices. Indian J Pediatr. 2010 Sep;77(9):987-91. doi: 10.1007/s12098-010-0158-2. Epub 2010 Aug 25.
26. Vogiatzi MG Macklin EA, Trachtenberg FL, Fung EB, Cheung AM, Vichinsky E, Olivieri N, Kirby M, Kwiatkowski JL, Cunningham M, Holm IA, Fleisher M, Grady RW, Peterson CM, Giardina PJ; Thalassemia Clinical Research Network. Differences in the prevalence of growth, endocrine and vitamin D abnormalities among the various thalassaemia syndromes in North America. Br J Haematol. 2009 Sep;146(5):546-56. doi: 10.1111/j.1365-2141.2009.07793.x. Epub 2009 Jul 13. [PubMed]
27. Tsitoura S, Amarilio N, Lapatsanis P, Pantelakis S, Doxiadis S. Serum 25-hydroxyvitamin D levels in thalassaemia. Arch Dis Child. 1978 Apr;53(4):347-8. [PubMed]
28. Pirinççioğlu AG, Akpolat V, Köksal O, Haspolat K, Söker M. Bone mineral density in children with beta-thalassemia major in Diyarbakir. Bone. 2011 Oct;49(4):819-23. doi: 10.1016/j.bone.2011.07.014. Epub 2011 Jul 23.
2. Higgs DR, Engel JD, Stamatoyannopoulos G. Thalassaemia. Lancet. 2012 Jan 28;379(9813):373-83. doi: 10.1016/S0140-6736(11)60283-3. Epub 2011 Sep 9. [PubMed]
3. Perrotta S, Gallagher PG, Mohandas N. Hereditary spherocytosis. Lancet. 2008 Oct 18;372(9647):1411-26. doi: 10.1016/S0140-6736(08)61588-3. [PubMed]
4. Satwani H, Raza J, Alam M, et al. Endocrine Complications in Thalassemias: Frequency and Association with Serum Ferritin Levels. Pak Paediat Assoc J. 2005;29:113–9.
5. Condamine L, Vztovsnik F, Friedlander G, Menaa C, Garabedian M. Local action of phosphate depletion and insulin-like growth factor–I on in vitro production of 1,25-dihydroxyvitamin D3 by cultured mammalian kidney cells. J Clin Invest. 1994;94:1673–1679.
6. Wright NM, Papadea N, Wentz B, Hollis B, Willi S, Bell NH. Increased serum 1,25-dihydroxyvitamin D after growth hormone administration is not parathyroid hormone-mediated. Calcif Tissue Int. 1997 Aug;61(2):101-3
7. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30. doi: 10.1210/jc.2011-0385. Epub 2011 Jun 6.
8. Mahachoklertwattana P, Sirikulchayanonta V, Chuansumrit A, Karnsombat P, Choubtum L, Sriphrapradang A, Domrongkitchaiporn S, Sirisriro R, Rajatanavin R. Bone histomorphometry in children and adolescents with beta-thalassemia disease: iron-associated focal osteomalacia. J Clin Endocrinol Metab. 2003 Aug;88(8):3966-72. [PubMed]
9. De Sanctis V, Vullo C, Bagni B, Chiccoli L. Hypoparathyroidism in beta-thalassemia major. Clinical and laboratory observations in 24 patients. Acta Haematol. 1992;88(2-3):105-8. [PubMed]
10. Singh K, Kumar R, Shukla A, Phadke SR, Agarwal S. Status of 25-hydroxyvitamin D deficiency and effect of vitamin D receptor gene polymorphisms on bone mineral density in thalassemia patients of North India. Hematology. 2012 Sep;17(5):291-6. doi: 10.1179/1607845412Y.0000000017.
11. Nakavachara P, Viprakasit V. Children with hemoglobin E/β-thalassemia have a high risk of being vitamin D deficient even if they get abundant sun exposure: a study from Thailand. Pediatr Blood Cancer. 2013 Oct;60(10):1683-8. doi: 10.1002/pbc.24614. Epub 2013 Jun 3. [PubMed]
12. Giardina PJ, Forget BG. Thalassemia syndromes. In: Hoffman R, Benz EJ, Shattil SS, et al., editors. Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008. chap 41.
13. Raiola G, Galati MC, De Sanctis V, Caruso Nicoletti M, Pintor C, De Simone M, Arcuri VM, Anastasi S. Growth and puberty in thalassemia major. J Pediatr Endocrinol Metab. 2003 Mar;16 Suppl 2:259-66. [PubMed]
14. Bielinski BK, Darbyshire PJ, Mathers L, Crabtree NJ, Kirk JM, Stirling HF, Shaw NJ. Impact of disordered puberty on bone density in beta-thalassaemia major.Br J Haematol. 2003 Jan;120(2):353-8. [PubMed]
15. Hashemi A, Ghilian R, Golestan M, et al. The study of growth in thalassemic patients and its correlation with serum ferritin level. IJPHO. 2011;1(4):147–51. [PubMed]
16. Jain M, Sinha RS, Chellani H, Anand NK. Assessment of thyroid functions and its role in body growth in thalassemia major. Indian Pediatr. 1995 Feb;32(2):213-9. [PubMed]
17. Shamshirsaz AA, Bekheirnia MR, Kamgar M, Pourzahedgilani N, Bouzari N, Habibzadeh M, Hashemi R, Shamshirsaz AA, Aghakhani S, Homayoun H, Larijani B. Metabolic and endocrinologic complications in beta-thalassemia major: a multicenter study in Tehran. BMC Endocr Disord. 2003 Aug 12;3(1):4. [PubMed]
18. Kassab-Chekir A, Laradi S, Ferchichi S, Haj Khelil A, Feki M, Amri F, Selmi H, Bejaoui M, Miled A. Oxidant, antioxidant status and metabolic data in patients with beta-thalassemia. Clin Chim Acta. 2003 Dec;338(1-2):79-86. [PubMed]
19. Hamed EA, El-Melegy NT. Renal functions in pediatric patients with beta-thalassemia major: relation to chelation therapy: original prospective study. Ital J Pediatr. 2010;36:39. [PubMed]
20. Zamboni G, Marradi P, Tagliaro F, Dorizzi R, Tatò L. Parathyroid hormone, calcitonin and vitamin D metabolites in beta-thalassaemia major. Eur J Pediatr. 1986 Apr;145(1-2):133-6. [PubMed]
21. Aleem A, Al-Momen AK, Al-Harakati MS, Hassan A, Al-Fawaz I. Hypocalcemia due to hypoparathyroidism in beta-thalassemia major patients. Ann Saudi Med. 2000 Sep-Nov;20(5-6):364-6. [PubMed]
22. Vogiatzi MG, Autio KA, Mait JE, Schneider R, Lesser M, Giardina PJ. Low bone mineral density in adolescents with beta-thalassemia. Ann N Y Acad Sci. 2005;1054:462-6. [PubMed]
23. Mahachoklertwattana P, Chuansumrit A, Choubtum L, Sriphrapradang A, Sirisriro R, Rajatanavin R. Bone mineral density in children and young adults with beta-thalassemia trait. J Pediatr Endocrinol Metab. 2002 Nov-Dec;15(9):1531-5. [PubMed]
24. Di Stefano M, Chiabotto P, Roggia C, Garofalo F, Lala R, Piga A, Isaia GC. Bone mass and metabolism in thalassemic children and adolescents treated with different iron-chelating drugs. J Bone Miner Metab. 2004;22(1):53-7. [PubMed]
25. Merchant R, Udani A, Puri V, D'cruz V, Patkar D, Karkera A. Evaluation of osteopathy in thalassemia by bone mineral densitometry and biochemical indices. Indian J Pediatr. 2010 Sep;77(9):987-91. doi: 10.1007/s12098-010-0158-2. Epub 2010 Aug 25.
26. Vogiatzi MG Macklin EA, Trachtenberg FL, Fung EB, Cheung AM, Vichinsky E, Olivieri N, Kirby M, Kwiatkowski JL, Cunningham M, Holm IA, Fleisher M, Grady RW, Peterson CM, Giardina PJ; Thalassemia Clinical Research Network. Differences in the prevalence of growth, endocrine and vitamin D abnormalities among the various thalassaemia syndromes in North America. Br J Haematol. 2009 Sep;146(5):546-56. doi: 10.1111/j.1365-2141.2009.07793.x. Epub 2009 Jul 13. [PubMed]
27. Tsitoura S, Amarilio N, Lapatsanis P, Pantelakis S, Doxiadis S. Serum 25-hydroxyvitamin D levels in thalassaemia. Arch Dis Child. 1978 Apr;53(4):347-8. [PubMed]
28. Pirinççioğlu AG, Akpolat V, Köksal O, Haspolat K, Söker M. Bone mineral density in children with beta-thalassemia major in Diyarbakir. Bone. 2011 Oct;49(4):819-23. doi: 10.1016/j.bone.2011.07.014. Epub 2011 Jul 23.
CITATION
DOI: 10.17511/ijpr.2016.i09.04
Published: 2016-09-30
How to Cite
Dr. Anika Agrawal, Dr Manisha Garg, Dr. Jagdish Singh, Dr Priyanshu Mathur, & Dr. Khurshida Khan. (2016). A comparative study of 25 hydroxy vitamin D levels in patients of thalassemia and healthy children. Pediatric Review: International Journal of Pediatric Research, 3(9), 652-656. https://doi.org/10.17511/ijpr.2016.i09.04
Section
Original Article
Copyright (c) 2016 Author (s). Published by Siddharth Health Research and Social Welfare Society
This work is licensed under a Creative Commons Attribution 4.0 International License.
OAI - Open Archives Initiative
