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Assessment of red blood cell indices in growth-hormone-treated children
G Valerio1, S Di Maio, M Salerno
1Departments of Pediatrics, University of Udine, School of Medicine, Italy.
Insights
Growth hormone (GH) treatment stimulates red blood cell (RBC) production in GH-deficient children, improving hemoglobin and hematocrit levels. This effect highlights GH
Area of Science:
- Endocrinology
- Hematology
- Pediatrics
Background:
- Growth hormone (GH) deficiency can impact various physiological processes, including erythropoiesis.
- Red blood cell (RBC) indices are crucial indicators of oxygen-carrying capacity and overall hematological health.
- Understanding the role of GH in erythropoiesis is essential for managing endocrine disorders in children.
Purpose of the Study:
- To evaluate the effect of recombinant human GH (rhGH) on erythropoiesis in GH-deficient children.
- To compare RBC indices in GH-deficient children before and after rhGH therapy.
- To investigate the influence of GH on RBC production in children with isolated GH deficiency versus multiple pituitary hormone deficiencies and in Ullrich-Turner syndrome (UTS).
Main Methods:
- Comparison of RBC indices (hemoglobin, hematocrit, RBC count, MCV) expressed as standard deviation scores (SDS) between 19 GH-deficient children and 57 healthy controls.
- Analysis of RBC indices in GH-deficient children after 3 and 6 months of rhGH treatment.
- Comparison of RBC indices in 9 UTS patients undergoing GH therapy.
Main Results:
- GH-deficient children exhibited significantly lower Hb-SDS, Ht-SDS, and RBC-SDS compared to controls.
- rhGH therapy led to a significant increase in Hb-SDS, Ht-SDS, and RBC-SDS in GH-deficient children within 3-6 months.
- No significant changes in RBC indices were observed in UTS patients treated with rhGH.
Conclusions:
- GH has a direct stimulatory effect on erythropoiesis, particularly evident in conditions of GH deficiency.
- GH plays a permissive role in the hematopoietic system, with its deficiency potentially impairing RBC production.
- The positive impact of GH on erythropoiesis appears specific to GH deficiency states and not observed in UTS.
Abstract:
In order to evaluate the effect of growth hormone (GH) on erythropoiesis, red blood cell (RBC) indices (hemoglobin, Hb; hematocrit, Ht; RBC count, and mean corpuscular volume, MCV) of 19 GH-deficient children (12 with isolated GH deficiency and 7 with multiple pituitary hormone deficiencies) between 2 months and 15 years of age were compared to those of 57 sex- and age-matched short normal controls before starting treatment with recombinant human GH (rhGH). The RBC indices were expressed as standard deviation score (SDS). Moreover, the RBC indices in the GH-deficient group were analyzed after the first 3 and 6 months of GH treatment and compared to those of 9 Ullrich-Turner syndrome (UTS) patients with GH therapy. Both patients with isolated and those with multiple pituitary hormone deficiencies presented significantly lower values of Hb-SDS (-1.6 +/- 1.0 and -2.0 +/- 1.4, respectively; p = 0.004), Ht-SDS (-1.55 +/- 0.9 and -2.5 +/- 2.1, respectively; p = 0.001) and RBC-SDS (-0.6 +/- 1.6 and -1.2 +/- 0.9, respectively; p = 0.002) when compared to controls (Hb-SDS: -0.6 +/- 1.4; Ht-SDS: -0.1 +/- 1.9; RBC-SDS: 0.17 +/- 1), in the presence of comparable MCV-SDS values. In contrast, RBC indices did not differ between patients with isolated and those with multiple pituitary hormone deficiencies. When the variations of RBC indices were analyzed after 3 and 6 months of rhGH therapy in the 19 GH-deficient children, an increase in the Hb-SDS (p = 0.01), Ht-SDS (p = 0.03) and RBC-SDS was observed, indicating an early stimulatory effect on RBC proliferation in these patients. However, an analysis of the RBC indices in the group of UTS patients did not reveal any significant change after both 3 and 6 months of therapy with rhGh. The increase in Hb, Ht, and RBC count observed during GH treatment confirms the in vivo erythropoietic growth-promoting effects of GH. However, this effect seems to be related only to conditions of GH deficiency. When GH deficiency is associated with multiple pituitary hormone deficiencies there are pathological influences on erythropoiesis which are not corrected until Gh treatment is started, indicating a 'permissive' role of GH in the hematopoietic system.