Study of prevalence of abnormal glucose tolerance in transfusion-dependent thalassemia patients

Beta Thalassemia is a chronic hemolytic anemia in which treatment by regular transfusion of packed Red blood cells [RBC] is the mainstay of patient's care. The resulting iron overload is the major cause of morbidity for these patients. Deposition of iron in the liver, endocrine glands and in the heart results in hemochromatosis in these organs. Type 2 diabetes is a common complication of iron overload. The development of diabetes in hemochromatosis is related to the magnitude of excess iron. The aim of the present work was to study the prevalence of abnormal glucose tolerance in thalassemia patients and detect whether increased echogenicity of the pancreas is correlated to the magnitude of iron excess, and to study the relation between hemosiderosis and pancreatic dysfunction. For this work, we first examined forty four patients with thalassemia major attending the Hematology Unit of Damanhour Medical National institute [DMNI]. Later on the number of patients enrolled in the study extended to ninety. Laboratory assay included fasting serum glucose level [FSG], 2 hours post prandial serum glucose level [PPSG], serum ferritin [S-Fe] and abdominal ultrasound [U/S]. The study showed that hemochromatosis was associated with increased pancreatic echogenicity and abnormal glucose level. Serum ferritin concentration and hepatitis C infection are risk factors for abnormal glucose found in transfusion-dependent thalassemia patients. Early aggressive iron chelation therapy and prevention of infections are the most important issues in managing glucose intolerance in transfusion-dependent Beta thalassemia patients

Effect of chronic hepatitis C virus on glucose metabolism among transfusion dependent beta thalassemia patients

The major clinical problem in patients with beta thalassemia is iron overload usually resulting from increased exogenous iron absorption from repeated transfusion. Hepatic and pancreatic damage are often present among these subjects. The factors of hemosiderosis and the possibility of hepatitis C virus [HCV] transmission because of polytransfusion contribute to hepatic injury and cirrhosis. Abnormal glucose tolerance is a frequent complication inflicted by iron overload to the pancreatic beta cells. The present study was conducted in the Hematology Unit of Damanhur Medical National Institute [DMNI] on thalassemic patients receiving packed red blood cells [RBCs] on a regular basis, aiming at studying the effect of HCV on their glucose metabolism. The selected patients were subjected to history taking, thorough clinical examination, anthropometric measurements and laboratory assay for complete blood picture [CBC], serum ferritin [S-Fe], fasting serum glucose [FSG] and 2 hours post prandial serum glucose [PPSG] levels. Results showed that 53.4% of the selected patients had impaired fasting glucose and 12.5% discovered their diabetic state just at the time of the study. The 2h PPSG level was impaired in 29.5% of the patients. There was a significant difference between the mean age, BMI and hemoglobin levels of HCV seropositive patients when compared to seronegative ones. The same also applies to the mean values of FSG, 2h PPSG, and glycated hemoglobin percentage as well as liver enzymes [ALT, AST] and serum ferritin levels. There was a strong positive association between level of serum ALT and HCV infection and an intermediate association between HCV infection and FSG, 2h PPSG level, Hb A[1c] serum ferritin and serum AST. The duration of transfusion was positively correlated to FSG, 2h PPSG, Hb A[1c], and negatively related to nutritional indicators: HAZ and WAZ

Conclusion: polytransfusion dependent thalassemia patients are at greater risk for developing diabetes mellitus probably secondary to HCV infection. High levels of serum ferritin and hepatitis C infection together with the long duration of transfusion presented by age of patients could be considered among independent risk factors for the development of abnormal glucose metabolism among transfusion dependent thalassemia patients

Blood count profile in chronic active hepatitis [C] Egyptian patients

Hepatitis C virus [HCV] is one of the most important causes of chronic hepatitis globally, and particularly in Egypt. Abnormal blood counts have been noted in clinics among patients with HCV infection. The present work is a case control study conducted in Damanhour Medical National Institute [DMNI] to evaluate the frequency and severity of peripheral blood cell abnormalities in HCV- infected Egyptian patients. Two groups of individuals were randomly selected, group 1 comprised 100 patients suffering from chronic active hepatitis C with positive RNA PCR, and group 2 comprised 100 healthy persons and represented the control group. Low neutrophil and platelet counts, but not anemia were noticed in the first group and were significantly different when compared to the control group [<2.1x10[9]/L in 27% of patients versus 10% of controls and <175x10[9]/L in patients versus 11% of controls respectively at p<0.01]. Obesity, advanced age and anti HCV seropositivity were independently associated with neutropenia, while advanced age and female gender and anti HCV seropositivity were associated with thrombocytopenia among HCV infected patients

Ramadan fasting: relation to atherogenic risk among obese muslims

Increased platelet aggregation as well as changes in coagulation factors have an important effect on the occurrence of atherogenicity and cardiovascular diseases. Fasting in general has been used in medicine for medical purposes when other measures fail. Since Ramadan fasting is different from total fasting, the present work was conducted to study the effect of Ramadan fasting on lipid pattern, some blood coagulation parameters, blood pressure and body mass index [BMI] - as atherosclerotic risk factors - in one hundred and three apparently healthy obese volunteers [15 men and 88 women] aged 15-52 years. The study comprised an initial visit for assessment V1 [before Ramadan] and three other follow up visits: V2 [at the end of Ramadan], V3 [4 weeks after Ramadan] and V4 [8 weeks after Ramadan], Targets were subjected to an interview questionnaire, complete physical and clinical examination, anthropometric measurements, dietary profile, and laboratory assay of complete blood picture [CBC], fasting serum glucose level [FSG], serum lipid pattern: total cholesterol [TC], triglycerides [TG], high density lipoproteins [HDL-c] and low density lipoprotein [LDL-c], lipoprotein a Lp [a], apolipoprotein A1 [APA], and apolipoprotein B [APB] levels; bleeding [BT] and clotting time [CT], prothrombin time [PT], activated partial thromboplastin time [APTT], fibrinogen and plasma factor VII activity. Statistical analysis was performed using Chi squared, Fisher exact, Student t test, paired t test and Pearson's correlation coefficient. Statistical significance was defined at P<0.05. The study showed that by the end of Ramadan fasting, there was a significant improvement in the mean levels of hemoglobin [Hb], TC, TG, HDL-c, LDL-c, TC/HDL, LDL/HDL, Lp [a], APA, APB, PT and systolic [SBP] and diastolic blood pressure [DBP] that persisted for four weeks after fasting [P<0.05]. Ramadan fasting has not adversely affected leucocytic count or coagulation parameters [P>0.05]. There was also a significant association between dietary intake, SBP, DBP, weight, BMI, percent body fat and waist, fibrinogen and factor VII activity and TC, TG, HDL-c, LDL-c, LDL/HDL, Lp [a] and APB [P<0.05]. The model of Ramadan fasting could be followed as a behavior modification program to control or prevent atherogenicity because of its positive impact on the lipid pattern, blood count and coagulation parameters