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Perspective
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Changes in the Iron Indices is a Major Reason of Serum Hormone Disturbance in Thalassemia Patients
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Idress Hamad Attitalla
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ABSTRACT
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Illness a major health issue and it is effecting individual and society in
different ways. As technology is being advanced day by day, many diseases are
highlighted like hemophilia, blood cancer, thalassemia etc. ( Farid
et al., 2002). Thalassemia is inherited blood disorder in which body
makes an abnormal form of hemoglobin. This disorder produces anemia due to the
excessive destruction of red blood cells. Hemoglobin is core component of the
blood and Alpha globin and beta globin proteins are its components. Whenever,
there is a fault in production of these proteins, thalassemia results. Thalassemia
is of two types. Alpha thalassemia is caused by the mutation in genes of alpha
globin protein and Asia, China and African decent, Middle east are the countries
where it is prevailing.
The second type is Beta thalassemia which occurs due to similar gene defects
which may alter the production of the beta globin protein and commonly found
in Chinese, other Asians and African countries. It is found in lesser extent
as compared to Alpha thalassemia (Pubmed Medicine, 2011).
In Iraq, thalassemia is a serious problem due to the non-availability of equipment
and drugs during different periods of mayhem and war. Hassan
et al. (2003) made a research on 1064 couples that were hired from
the Public Health Laboratory in Basra. They concluded that 5% of the total couples
were having the beta-thalassemia trait while 11.48% were the major victims of
beta-thalassemia disease. They further said that situation is alarming and required
an effective management plan including public health education programs to facilitate
early diagnosis and treatment. The patients of thalassemia are dependent on
blood transfusions to maintain the levels of hemoglobin and packed cell volume
in their blood but repeated transfusions lead to amassing of iron in tissues
of the endocrine glands. These disorders have been resulted the hemosiderosis
of gonadotroph cells of the pituitary gland (Abdelrazik
and Ghanem, 2007). In many previous studies, long-term natural history of
thyroid dysfunction is poorly described due to the prevalence of different school
of thoughts about its prevention and severity measures. Despite the deferoxamine
therapy, secondary endocrine dysfunction risk is persistent (Al-Rimawi
et al., 2006). Hypogonadism was one of the most frequent endocrine
complications while impaired glucose tolerance, short-physique and hypocalcemia
were also the major contributor (Najafipour et al.,
2008).
Abdulzahra et al. (2011) made a research and
identified the effect of iron excess on endocrine gland functions by estimating
the ability of endocrine gland to produce sufficient amount of some hormones.
Their results showed a mild decline in the function of endocrine glands through
the decrease in the level of some hormones. There was no considerable difference
between thalassemia patients and healthy individuals when Serum T3, T4 and TSH
assay were analyzed.
They claimed that reduction of total body iron store is an important goal for
the treatment of thalassemia and measuring the hormones concentration is necessary
for the follow up of the thalassemic patients especially during puberty. Saka
et al. (1995) made a research and found that there was a major dissimilarity
in the mean serum ferritin levels between patients suffering from thalassemia
with endocrine problems and without endocrine problems. They also pointed out
that the increased iron storage in the endocrine glands had destructive effect.
Moayeri and Oloomi (2006) made a study and found that
thalassemia patients were small in height as compared to healthy individuals;
it means there should be an active monitoring to have a check on endocrine malfunctioning
in a suitable age In another study, it is found that FSH level of thalassemia
patient was not different from normal individuals (Masala
et al., 1984) while some studies indicated the decreased FSH and
LH values in patients suffering from thalassemia than the normal individuals
(Moayeri and Oloomi, 2006). Abdelrazik
and Ghanem (2007) found in an investigation that thalassemia patients may
not be able to develop puberty so there is strong need to make efforts for its
treatment, careful blood transfer and accurate chelation therapy. Many studies
indicated no significant difference of testosterone serum level in thalassemia
patients and controls (Dundar et al., 2007).
Al-Hader et al. (1993) have stated that impaired
thyroid function is present in a considerable proportion of transfusion-dependent
beta-thalassemia patients.
Iron indices are responsible for serum hormone level disorder during the on
setting of puberty in thalassemia patients. The precise monitoring of iron status
is important to prevent possible damage to vital organs because functional fluctuations
found in some hormone levels can be explained as a consequence of coexisting
hemosiderosis. Major thalassemia may affect the function of several endocrine
glands. So, it is suggested that physicians should be aware of the endocrine
abnormalities and precise treatment procedure for timely-disease-control.
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