RESUMO
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