Microcytosis in children and adolescents with the sickle cell trait in Basra, Iraq

BACKGROUND: Microcytic anemia, the most common form of anemia in children and adolescents, is a heterogeneous group of diseases that is acquired or inherited. We assessed the frequency and causes of microcytosis in children and adolescents with the sickle cell trait (SCT). METHODS: This descriptive study included 95 subjects (49 males and 46 females) with SCT who attended Basra Center for Hereditary Blood Diseases for evaluation. Investigations included complete blood count, high performance liquid chromatography, capillary electrophoresis, and measurement of serum ferritin and transferrin levels. RESULTS: SCT subjects had a low hemoglobin (Hb) concentration (9.79±1.75 g/dL), low mean corpuscular volume (MCV, 67.43±9.22), low mean corpuscular Hb (21.15±3.64), and a normal red cell distribution width (RDW, 14.00±2.30). Among 95 SCT subjects, 81 (85.26%) had microcytosis, 12 (12.63%) had normal MCV, and 2 (2.11%) exhibited macrocytosis. Sixty-three (77.78%) SCT subjects with microcytosis were iron deficient, and 18 (22.22%) had normal iron levels. The mean serum ferritin and HbA2 levels were significantly lower, while the RDW, sickle Hb, and serum transferrin levels were significantly higher in patients with microcytosis and iron deficiency compared to non-iron deficient subjects (P0.05). CONCLUSION: Despite the frequent occurrence of iron deficiency in SCT subjects, co-inheritance of alpha-thalassemia seemed to be the cause of low MCV in non-iron deficient individuals with microcytosis. Genetic analysis is required to understand the genetic basis of this phenomenon.

Antioxidant status in acute asthmatic attack in children

To determine the oxidant - antioxidant imbalance in asthmatic children, by measuring the levels of malondialdehyde [MDA] as an oxidant marker of lipid peroxidation as well as antioxidant compounds like vitamin C, vitamin E and uric acid and to investigate whether their concentrations are associated with more severe asthma. This case controlled prospective study was conducted on 219 children aged 1-12 years, attending Basra Maternity and Children Hospital. Included were 98 asthmatic children during acute attack and 121 non-asthmatic, apparently healthy children. Serum malondialdehyde [MDA] as an oxidant marker of lipid peroxidation, and vitamin C, vitamin E and uric acid [as antioxidants] were estimated in asthmatic children during acute attack-and compared with non-asthmatic children. Asthmatic children during exacerbation of their asthma have significant lower serum levels of antioxidant compounds like vitamin C, vitamin E and uric acid [p<0.001] and significantly high malondialdehyde as compared with the controls. MDA was significantly elevated [P< 0.001], while that of vitamin C, vitamin E and uric acid were significantly decreased with increasing severity of asthmatic attack [P<0.001]. A significant negative correlation between MDA with vitamin C [P<0.05, r = - 0.44] was observed in severe asthmatic attacks. Asthmatic patients during acute attack suffer a high degree of reactive oxygen species formation causing considerable oxidative stress that is indicated by the high level of oxidants [MDA] and low level of antioxidants

Hyponatremia in children with acute central nervous system diseases

Hyponatremia is a common electrolyte disturbance and its potential neurological sequelae make its differential diagnosis mandatory before any therapeutic intervention. The study was conducted to estimate the frequency of hyponatremia among children hospitalized with acute cerebral insult and to look for the possible causes of hyponatremia. Prospective case-control study. Basrah maternity and children hospital. Case-control study performed on 150 children [87 boys and 63 girls], during 9 months [from the first of October 2003 till the end of June 2004]. Their ages ranged from 2-108 months. Seventy five of them presented with acute central nervous system [CNS] manifestations, while the rest were considered as control. Serum sodium, potassium, glucose and urea nitrogen were estimated and serum osmolality was calculated. In addition, urinary sodium, potassium, glucose, urea and creatinine determination was done, and urine osmolality was calculated. Eight of 75 pediatric patients [10.7%] with acute CNS diseases had hyponatremia syndrome, 3 of which were diagnosed with inappropriate antidiuretic hormone secretion. Another 2 patients showed signs of dehydration and evidence of cerebral salt wasting. In the remaining 3 patients the clinical and laboratory data were insufficient for further classification. The highest percentage of hyponatremia [3 out of 6 patients; 50%] was found in patients with intracranial diseases. Four out of 38 patients [15.5%] presented with CNS infections. Mean serum levels of glucose, sodium and osmolality were significantly lower in all patients with acute CNS diseases compared with the control, while urinary urea and osmolality levels were significantly higher in those patients as compared with the control group. The study showed that there was a significant decrease in the mean serum level of glucose, sodium and osmolality in hyponatremic patients compared to non-hyponatremic patients. There was also a significant increase in urine sodium/creatinine ratio, urea, and osmolality in hyponatremic patients compared to non-hyponatremic patients. The study has demonstrated that serum urea was significantly higher in patients with cerebral salt wasting compared to those with syndrome of inappropriate antidiuretic hormone secretion. In addition to that, the 3 groups of hyponatremia have significant differences in the mean urine sodium, urea, osmolality and serum osmolality. From this study, we may conclude that hyponatremia is not uncommon in patients with acute central nervous system [CNS] insults. Serum sodium should be routinely monitored in these patients to enable early diagnosis and treatment of hyponatremia