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Assessment of Serum Vitamin D and Parathyroid Hormone in Children With Beta Thalassemia Major: A Case-Control Study
Rajkumar M Meshram1, Manan A Salodkar1, Shruti R Yesambare1
1Paediatrics, Government Medical College and Hospital, Nagpur, IND.
Insights
Children with beta-thalassemia show significantly lower vitamin D and parathyroid hormone (PTH) levels, potentially impacting growth. These deficiencies may stem from iron overload and poor nutrition, warranting attention in treatment strategies.
Area of Science:
- Pediatric Endocrinology
- Hematology
- Nutritional Science
Background:
- Vitamin D deficiency impacts calcium homeostasis and bone health, particularly in chronic endocrinopathies.
- Beta-thalassemia is associated with endocrine dysfunctions and metabolic bone diseases.
- Understanding mineral and vitamin status in children with beta-thalassemia is crucial for managing complications.
Purpose of the Study:
- To investigate serum calcium, vitamin D, and parathyroid hormone (PTH) levels in children diagnosed with beta-thalassemia.
- To compare these levels between children with beta-thalassemia and a healthy control group.
- To explore potential links between these deficiencies and the disease's complications.
Main Methods:
- A case-control study involving 36 children with major beta-thalassemia and 36 age- and sex-matched controls.
- Serum levels of vitamin D and PTH were measured using electrochemiluminescence and immunoassay techniques, respectively.
- Statistical analyses included the student's t-test, Mann-Whitney, and chi-square tests to compare groups.
Main Results:
- Children with beta-thalassemia exhibited significantly lower hemoglobin (5.62±1.9 g/dL) and higher serum ferritin (3073±1262.24 ng/mL) levels compared to controls.
- A high prevalence of vitamin D deficiency (80.6%) and PTH deficit (72.2%) was observed in the beta-thalassemia group (p<0.001).
- Mean serum calcium (8.51±0.84 mg/dL), vitamin D (15.23±10.07 ng/mL), and PTH (14.66±19.86 pg/mL) were significantly lower in cases than controls.
Conclusions:
- Markedly reduced serum calcium, vitamin D, and PTH levels in children with beta-thalassemia may contribute to growth failure.
- Excessive iron accumulation and inadequate nutritional support are potential causes for these biochemical anomalies.
- Treatment strategies should consider addressing these endocrine and nutritional disturbances in pediatric beta-thalassemia patients.
Background:
A defective synthesis of vitamin D contributes to alterations in calcium homeostasis due to chronic endocrinopathies, leading to metabolic bone diseases. This study aimed to ascertain the levels of calcium, vitamin D, and parathyroid hormone (PTH) in children with β-thalassemia.
Methods:
In this case-control study, 36 children with major β-thalassemia receiving iron chelation therapy were included. For the control group, 36 cases matched for age and sex were selected. The packed cell volume (PCV) requirements varied among the thalassemic children, with an average PCV requirement of 78.57±49.07. The study was conducted for six months in the Department of Pediatrics at the Government Medical College, Nagpur, India. Serum PTH levels were determined by immunoassay, and serum vitamin D levels were assessed using electrochemiluminescence technique. Additional tests looked at liver function, serum ferritin, calcium, phosphorus, and complete blood count. The student's t-test, Mann-Whitney, and chi-square tests were used for statistical analysis.
Result:
In comparison to the control group (10.4±1.21 g/dL), the case group's mean hemoglobin level was considerably lower (5.62±1.9 g/dL) (p<0.001). The mean serum ferritin level in the cases was notably higher (3073±1262.24 ng/mL) compared to the control group's level (58.37±29.67 ng/mL) (p<0.001). A total of 80.6% of cases compared to 5.6% of controls had vitamin D deficiency, and 72.2% of cases compared to 2.8% of controls had PTH deficit, both of which showed statistically significant differences (p<0.001). Significant differences were observed between the case and control groups for the mean levels of total serum calcium (8.51±0.84 mg/dL), vitamin D (15.23±10.07 ng/mL), and PTH (14.66±19.86 pg/mL) (9.13±0.6 mg/dL, p=0.05; 34.94±9.57 ng/mL, p<0.001; 32.08±12.42 pg/mL, p<0.001; respectively).
Conclusion:
Growth failure may result from the markedly reduced serum calcium, vitamin D, and PTH levels in children with β-thalassemia. The relevance of treatment approaches is highlighted by the possibility that these anomalies are caused by excessive iron and inadequate nutritional support.
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