Abstract
The goal of the present study was to determine the levels of minerals in chronically transfused thalassaemic patients living in Antalya, Turkey and to determine mineral levels in groups using different iron chelators. Three iron chelators deferoxamine, deferiprone and deferasirox have been used to remove iron from patients’ tissues. There were contradictory results in the literature about minerals including selenium, zinc, copper, and magnesium in thalassaemia major patients. Blood samples from the 60 thalassaemia major patients (the deferoxamine group, n = 19; the deferiprone group, n = 20 and the deferasirox group, n = 21) and the controls (n = 20) were collected. Levels of selenium, zinc, copper, magnesium, and iron were measured, and all of them except iron showed no significant difference between the controls and the patients regardless of chelator type. Serum copper levels in the deferasirox group were lower than those in the control and deferoxamine groups, and serum magnesium levels in the deferasirox group were higher than those in the control, deferoxamine and deferiprone groups. Iron levels in the patient groups were higher than those in the control group, and iron levels showed a significant correlation with selenium and magnesium levels. Different values of minerals in thalassaemia major patients may be the result of different dietary intake, chelator type, or regional differences in where patients live. That is why minerals may be measured in thalassaemia major patients at intervals, and deficient minerals should be replaced. Being careful about levels of copper and magnesium in thalassaemia major patients using deferasirox seems to be beneficial.
Similar content being viewed by others
References
Fibach E, Rachmilewitz E (2008) The role of oxidative stress in hemolytic anemia. Curr Mol Med 8(7):609–619
Fung EB, Xu Y, Trachtenberg F, Odame I, Kwiatkowski JL, Neufeld EJ, Thompson AA, Boudreaux J, Quinn CT, Vichinsky EP (2012) Inadequate dietary intake in patients with thalassemia. J Acad Nutr Diet 112(7):980–990
Baksi AJ, Pennell DJ (2014) Randomized controlled trials of iron chelators for the treatment of cardiac siderosis in thalassaemia major. Front Pharmacol 5:217. doi:10.3389/fphar.2014.00217
Aaseth J, Skaug MA, Cao Y, Andersen O (2014) Chelation in metal intoxication-principles and paradigms. J Trace Elem Med Biol 31:260–266
Freeland-Graves JH, Sanjeevi N, Lee JJ (2014) Global perspectives on trace element requirements. J Trace Elem Med Biol 31:135–141. doi:10.1016/j.jtemb.2014.04.006
Sherief LM, Abd El-Salam SM, Kamal NM, El Safy O, Almalky MA, Azab SF, Morsy HM, Gharieb AF (2014) Nutritional biomarkers in children and adolescents with beta-thalassemia-major: an egyptian center experience. Biomed Res Int 2014:261761. doi:10.1155/2014/261761
El Missiry M, Hamed Hussein M, Khalid S, Yaqub N, Khan S, Itrat F, Uderzo C, Faulkner L (2014) Assessment of serum zinc levels of patients with thalassemia compared to their siblings. Anemia 2014:125452. doi:10.1155/2014/125452
Grubman A, White AR (2014) Copper as a key regulator of cell signalling pathways. Expert Rev Mol Med 16. doi: 10.1017/erm.2014.11
De Franceschi L, Brugnara C, Beuzard Y (1997) Dietary magnesium supplementation ameliorates anemia in a mouse model of beta-thalassemia. Blood 90(3):1283–1290
Maria C, Leonardo R, Pietro R, Mario V, Isabella V, Diana T (2010) Erythrocytes anion transport and oxidative change in beta-thalassaemias. Cell Biol Int 34(6):655–662. doi:10.1042/CBI20090472
Winter WE, Bazydlo LA, Harris NS (2014) The molecular biology of human iron metabolism. Lab Med 45(2):92–102
Roussou P, Tsagarakis NJ, Kountouras D, Livadas S, Diamanti-Kandarakis E (2013) Beta-thalassemia major and female fertility: the role of iron and iron-induced oxidative stress. Anemia 2013:617204. doi:10.1155/2013/617204
Bartfay WJ, Bartfay E (2001) Selenium and glutathione peroxidase with beta-thalassemia major. Nurs Res 50(3):178–183
Mashhadi MA, Heidari Z, Sepehri Z, Bakhshipour AR, Karimkoshte A (2014) The selenium status in thalassemia patients in South East of Iran. Int J Hematol Oncol Stem Cell Re 8(4):1–4
Nasr MR, Ali S, Shaker M, Elgabry E (2002) Antioxidant micronutrients in children with thalassaemia in Egypt. East Mediterr Health J 8(4-5):490–495
Al-Samarrai AH, Adaay MH, Al-Tikriti K, Al-Anzy MM (2008) Evaluation of some essential element levels in thalassemia major patients in Mosul district, Iraq. Saudi Med J 29(1):94–97
Piga A, Gaglioti C, Fogliacco E, Tricta F (2003) Comparative effects of deferiprone and deferoxamine on survival and cardiac disease in patients with thalassemia major: a retrospective analysis. Haematologica 88(5):489–496
Cappellini MD, Cohen A, Piga A, Bejaoui M, Perrotta S, Agaoglu L, Aydinok Y, Kattamis A, Kilinc Y, Porter J, Capra M, Galanello R, Fattoum S, Drelichman G, Magnano C, Verissimo M, Athanassiou-Metaxa M, Giardina P, Kourakli-Symeonidis A, Janka-Schaub G, Coates T, Vermylen C, Olivieri N, Thuret I, Opitz H, Ressayre-Djaffer C, Marks P, Alberti D (2006) A phase 3 study of deferasirox (ICL670), a once-daily oral iron chelator, in patients with beta-thalassemia. Blood 107(9):3455–3462. doi:10.1182/blood-2005-08-3430
Pepe A, Meloni A, Capra M, Cianciulli P, Prossomariti L, Malaventura C, Putti MC, Lippi A, Romeo MA, Bisconte MG, Filosa A, Caruso V, Quarta A, Pitrolo L, Missere M, Midiri M, Rossi G, Positano V, Lombardi M, Maggio A (2011) Deferasirox, deferiprone and desferrioxamine treatment in thalassemia major patients: cardiac iron and function comparison determined by quantitative magnetic resonance imaging. Haematologica 96(1):41–47. doi:10.3324/haematol.2009.019042
Haghpanah S, Zarei T, Zahedi Z, Karimi M (2013) Compliance and satisfaction with deferasirox (Exjade) compared with deferoxamine in patients with transfusion-dependent beta-thalassemia. Hematology 19(4):187–191. doi:10.1179/1607845413Y.0000000121
Trachtenberg FL, Gerstenberger E, Xu Y, Mednick L, Sobota A, Ware H, Thompson AA, Neufeld EJ, Yamashita R (2014) Relationship among chelator adherence, change in chelators, and quality of life in thalassemia. Qual Life Res 23(8):2277–2288. doi:10.1007/s11136-014-0671-2
Claster S, Wood JC, Noetzli L, Carson SM, Hofstra TC, Khanna R, Coates TD (2009) Nutritional deficiencies in iron overloaded patients with hemoglobinopathies. Am J Hematol 84(6):344–348. doi:10.1002/ajh.21416
Ozturk Z, Genc GE, Kupesiz A, Kurtoglu E, Gumuslu S (2015) Thalassemia major patients using iron chelators showed a reduced plasma thioredoxin level and reduced thioredoxin reductase activity, despite elevated oxidative stress. Free Radic Res 49(3):309–316. doi:10.3109/10715762.2015.1004327
Sultan S, Irfan SM, Kakar J, Zeeshan R (2015) Effect of iron chelator desferrioxamine on serum zinc levels in patients with beta thalassemia major. Malays J Pathol 37(1):35–38
Mashhadi MA, Sepehri Z, Heidari Z, Shirzaee E, Kiani Z (2014) The prevalence of zinc deficiency in patients with thalassemia in South East of Iran, sistan and baluchistan province. Red Crescent Med J 16 (8):e6243. doi:10.5812/ircmj.6243
Erdogan E, Canatan D, Ormeci AR, Vural H, Aylak F (2013) The effects of chelators on zinc levels in patients with thalassemia major. J Trace Elem Med Biol 27(2):109–111. doi:10.1016/j.jtemb.2012.10.002
Al-Samarrai AH, Adaay MH, Al-Tikriti KA, Al-Anzy MM (2008) Evaluation of some essential element levels in thalassemia major patients in Mosul district, Iraq. Saudi Med J 29(1):94–97
Kajanachumpol S, Tatu T, Sasanakul W, Chuansumrit A, Hathirat P (1997) Zinc and copper status of thalassemic children. Southeast Asian J Trop Med Public Health 28(4):877–880
Mashhadi MA (2013) Copper status in patients with thalassemia major in zahedan, Iran. Int J Hematol Oncol Stem Cell Res 7(3):21–24
Ghone RA, Kumbar KM, Suryakar AN, Katkam RV, Joshi NG (2008) Oxidative stress and disturbance in antioxidant balance in beta thalassemia major. Indian J Clin Biochem 23(4):337–340. doi:10.1007/s12291-008-0074-7
Mahyar A, Ayazi P, Pahlevan AA, Mojabi H, Sehhat MR, Javadi A (2010) Zinc and copper status in children with beta-thalassemia major. Iran J Pediatr 20(3):297–302
de Baaij JH, Hoenderop JG, Bindels RJ (2015) Magnesium in man: implications for health and disease. Physiol Rev 95(1):1–46. doi:10.1152/physrev.00012.2014
Naderi M, Sadeghi-Bojd S, Valeshabad AK, Jahantigh A, Alizadeh S, Dorgalaleh A, Tabibian S, Bamedi T (2013) A prospective study of tubular dysfunction in pediatric patients with beta thalassemia major receiving deferasirox. Pediatr Hematol Oncol 30(8):748–754. doi:10.3109/08880018.2013.823470
Acknowledgments
The authors would like to thank all members of the Pediatric Hematology Department, Akdeniz University Hospital. The authors would like to give special thanks to the patients, parents and healthy volunteers for their contribution to the study. This study was supported by a grant (Project no: 112S657) from TUBITAK (The Scientific and Technological Research Council of Turkey).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Genc, G.E., Ozturk, Z., Gumuslu, S. et al. Mineral Levels in Thalassaemia Major Patients Using Different Iron Chelators. Biol Trace Elem Res 170, 9–16 (2016). https://doi.org/10.1007/s12011-015-0441-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12011-015-0441-1