Iron profile of pregnant sickle cell anemia patients in Odisha, India

ABSTRACT Introduction: During pregnancy, the iron requirement increases to meet the optimal growth of the fetus and prevent iron deficiency anemia-related complications in the mother. However, in sickle cell disease (SCD) primarily due to repeated blood transfusions and hemolysis-induced recycling of iron, its supplementation during pregnancy remains questionable and may be harmful. Methods: Twenty-five pregnant women with homozygous SCD and 25 pregnant women with normal hemoglobin variants were included as cases and control, respectively. Pregnancy and sickle cell anemia (SCA) were diagnosed using standard protocols. The serum iron, serum ferritin, total iron-binding capacity (TIBC), percentage transferrin saturation and C-reactive protein were estimated, as per the manufacturer's protocol. The complete blood count was performed. The unpaired 't-test' was performed using the SPSS v23.0 and the principal component analysis (PCA) was performed using the online software MetaboAnalyst for statistical analysis. Main Results: The studied cases had significantly lower mean hemoglobin and higher mean corpuscular volume (MCV), compared to controls. The mean serum-iron, serum-ferritin and percentage transferrin-saturation in the cases were significantly higher than that of the controls, while the TIBC was lower in the cases (p < 0.0001). The mean level of serum iron, ferritin, percentage transferrin saturation and TIBC were 309.44 ± 122.40mcg/dl, 860.36 ± 624.64ng/ml, 42.6 ± 17.30% and 241.32 ± 96.30 mcg/dl, respectively, in the cases and 95.36 ± 41.90mcg/dl, 122.28 ± 49.70ng/ml, 15.83 ± 3.10% and 492.6 ± 149.40mcg/dl in the controls, respectively. Higher MCV, mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) with lower hemoglobin (Hb) were noted in the cases. The PCA revealed that the cases were more heterogeneous in terms of the variability of the iron status and hematological indices than the controls. Conclusion: The current study shows iron sufficiency in most cases of pregnancy with SCA and suggests that evaluation of iron status must be made before initiating iron prophylaxis in pregnant women with SCA, especially in regions having a high prevalence of sickle cell hemoglobinopathy.

Impact of hydroxyurea on hospital stay & analgesic utilization in sickle cell anaemia with vaso-occlusive crises

Background & objectives: Hydroxyurea (HU) has been useful in preventing sickle cell vaso-occlusive crises (VOC). A few studies also suggest utility of HU, during acute VOC. Sickle cell anaemia (SCA) is of high prevalence in western districts of Odisha State, India, and VOC is a common presentation, despite being mostly of Arab-Indian haplotype. This study was undertaken to evaluate the impact of HU on hospital stay and analgesic utilization in acute painful VOC of SCA. Methods: Homozygous sickle cell disease (HbSS) patients were categorized as cases who were receiving low-dose HU (10 mg/kg/day) and patients who were not on HU were considered as control. Days of hospital stay, analgesic utilization and visual analogue scale (VAS) score in patients were compared with that of control. Analgesics used to control pain were tramadol hydrochloride, ketorolac and diclofenac. Results: A total of 359 homozygous sickle cell disease (SCD) patients with VOC were studied (187 patients and 172 controls). The patient group had lesser mean days of hospital stay (1.4 days less than controls, P<0.001) and required lesser days of analgesic utilization than controls (1.18 days less than controls, P<0.001). Significant differences were observed between patients and controls concerning VAS score and amount of tramadol hydrochloride, ketorolac and diclofenac utilization (P<0.05). Interpretation & conclusions: In this study, HU was found to have beneficial effects in acute VOC of homozygous SCD, which includes shortening the duration of hospital stay and reducing the net amount of analgesic utilization during hospitalization

Clinical profile and lipid abnormalities in subclinical and overt primary hypothyroidism

Background: Overt and subclinical hypothyroidism, affects metabolism of lipids particularly that of cholesterol, low density lipoprotein and triglyceride. Hypercholesterolemia predisposes to atherosclerosis and thereby increases cardiovascular risks.Methods: Hundred patients of primary  hypothyroidism of age more than 15 yrs were included. Five milliliters of venous blood was drawn in fasting state and serum obtained; thyroid function test (TFT) and fasting lipid profile were performed. Based on the TFT, patients were categorized as sub clinical or overt hypothyroidism. Clinical data, thyroid and lipid profiles obtained were analyzed and compared using statistical methods.Results: Seventy patients were females and thirty were males in the ratio of 2.3:1. Most common age group was 51-60years followed by 41-50years. Most common symptom was generalised weakness followed by weight gain, cold intolerance, constipation, hair loss, paraesthesia’s. Most common signs were myxoedema, delayed ankle reflex relaxation, dry and  coarse skin, bradycardia, non-pitting peripheral edema, madarosis, pallor, goiter. Patients with Overt hypothyroidism had significantly higher serum levels of total cholesterol(249.1±31.7 mg/dl), Triglycerides (191.5±68.5 mg/dl) and LDL cholesterol(167.7±31 mg/dl) than the Subclinical hypothyroidism with total cholesterol(202±19.8),triglycerides(155.6±35) and LDL cholesterol(129±21.1) but HDL cholesterol  level remains normal in both overt  (44.0±4.7) and subclinical  (43.1±4.4)hypothyroidism respectively.Conclusions: Patients with Overt hypothyroidism had significantly higher levels of Total cholesterol, Triglycerides (TG) and LDL cholesterol than the Subclinical hypothyroidism but HDL cholesterol level remains normal in both. So, concomitant estimation of lipid profile in hypothyroidism patients is needed for early intervention and prevention of cardiovascular morbidity and mortality.