The Complex Interactions Between Micronutrients, Iron Overload, and Health Outcomes in Iraqi Thalassemia Patients

Beta thalassemia is a hereditary hematological condition characterized by inadequate or aberrant production of globin chains, resulting in diminished hemoglobin levels in erythrocytes and the occurrence of anemia [1]. The direct effect is an imbalance in the synthesis of α and β globin chains, leading to anemia due to ineffective erythropoiesis and hemolysis [2]. The homozygous state results in severe anemia, requiring frequent blood transfusions that cause iron accumulation. This subsequently leads to problems including diabetes mellitus, hypoparathyroidism, hypothyroidism, hypogonadism, heart dysfunction, and liver fibrosis [3]. Patients with thalassemia face a heightened risk of mineral deficiency due to elevated oxidative stress and the effects of iron chelation therapies. Thalassemia consequences encompass growth and developmental delays, cardiomyopathy, endocrinopathies, and osteoporosis. Minerals may serve a specific function in preventing these complications. This review presents an overview of essential minerals such as zinc (Zn), copper (Cu), selenium (Se), magnesium (Mg), and calcium (Ca) in patients with thalassemia major. We also emphasize that certain complications of thalassemia may arise from an increased demand for minerals or a deficiency of these minerals [4,5]. Additionally, iron overload contributes to oxidative stress through the excessive generation of free radicals, changes in serum element levels, and variations in antioxidant enzyme activity [6]. Considering that elements operate as activators and/or inhibitors in the human body and are vital for various biochemical activities, it is imperative to evaluate and monitor serum levels of these elements before and during the treatment of major β-thalassemia [7]. Serum concentrations of elements may also contribute to the early detection of this condition. There has been less emphasis on the atypical distribution or accumulation of elemental concentrations in the body, except iron, inside organs and biological fluids [8]. Because elements can either activate or inhibit biochemical processes in the body and play a key role in many others, it is important to find out and keep an eye on the blood levels of these elements before and during treatment for major β-, Serum levels of elements may also aid in the early diagnosis of this illness [8,9]. Thus far, minimal focus has been directed toward elemental concentrations in the body, aside from iron, that are irregularly distributed or aggregated in organs and biological fluids [6].

The aim of study

This study aimed to investigate the role of iron overload on the variations in micronutrient levels in patients diagnosed with significant β-thalassemia.

Subjects

Al-Shams Medical Laboratory in Diyala Governorate conducted this case-control study from August 2024 to December 2024. The study involved 100 participants, 50 of whom had significant β-thalassemia (25 males and 25 females) and 50 healthy controls (25 males and 25 females), aged 19 to 25.

Inclusion criteria

Patients aged 19-25 years with a confirmed diagnosis of β-thalassemia major who underwent blood transfusions one times per month to keep Hb 10 mg/dl were included in the study.

Recessive iron chelating

Criteria for exclusion

• Patients with current infections who had a splenectomy
• Patients don't take iron chelating

A blood sample of 4 ml was collected from each participant participating in this investigation under stringent aseptic conditions. The blood samples were meticulously transferred into gel tube containers specifically suited for the measurement of various factors. The containers were subsequently utilized to perform assays using the COBAS diagnostic test system, a product developed and marketed by Roche Diagnostics. This method ensured accurate and reliable testing of the collected samples for the required parameters during the study.

Statistical Examination

The statistical analysis of continuous variables was conducted using SPSS software version 20 (SPSS Inc., Chicago, IL, USA). The results were calculated as the mean and standard error, presented in the format Mean±standard error. A one-way analysis of variance (ANOVA) was employed to assess the data, with statistical significance determined at p<0.05 to find noteworthy differences.

Table 1 illustrated serum ferritin and iron, the level of serum ferritin and iron increased significantly in patients’ group (555.12±11.50 and 235.25±23.76 µg/dL) when compared with control group (48.20±2.27 and 70.58±1.63 µg/dL) (Figure 1).

Table 1: Descriptive and statistical test of ferritin and iron between groups

Figure 1: Ferritin and iron in increased in patients with β-thalassemia

Heterogeneous anechoic area

The statistical analysis illustrated increased in zinc, magnesium and manganese inpatient group (99.50±0.50 µg/L, 2.31±0.04 mg/dl and 11.92±0.54 ng/ml, l respectively) when compared with control group (88.60±0.62 µg/L, 1.86±0.02 mg/dl and 2.74±0.07 ng/ml, respectively) p-value 0.000 (Figure 2). Unlike that copper and calcium decrease significantly in patient group (81.62±0.49 µg/L and 9.23±0.13 mg/dl) when compared with control group (117.80±2.29 µg/L and 8.51±0.04 mg/dl) p-value 0.000 (Table 2, Figure 3).

Table 2: Descriptive and statistical test of micronutrients between groups

Figure 2: Zinc, magnesium and manganese increased in patients with β-thalassemia