Hemoglobin D Punjab is a hemoglobin variant that occurs mainly in northwest India with prevalence rate of 1%. Homozygous form is very rare and clinically more serious than heterozygous HbD. Here we present a case of HbD trait with mild anemia and slightly altered red cell indices in a 31year old female from South India. Decreased plasma trace elements (iron, copper, zinc) and altered metalloproteinsare the novel findings, emphasizing the need for periodic assessment and prompt supplementation of micronutrients to prevent red cell damage and related complications in hemoglobinopathies.
Objective: The study aims to evaluate the plasma trace element status in beta-thalassemia trait (BTT) patients and demonstrate the correlation between trace elements and hemoglobin (Hb)-A1, HbA2, and HbF.Methods: The study population consisted of 20 normal individuals and 40 patients with BTT aged between 25 and 55 years of both the sex. Hemoglobin variant analysis was performed in blood samples using cation exchange high-performance liquid chromatography. Patients were labeled as beta-thalassemia trait only if they had HbA2 >3.5% or HbF >2.0%. Plasma zinc was estimated by atomic absorption spectrometry, copper by bathocuproine disulfonate method, and iron by ferrozine method spectrophotometrically. Data were analyzed statistically by Student’s t -test and Pearson’s correlation using software SPSS version 20. p<0.05 was considered statistically significant.Results: Plasma zinc and copper decreased significantly in BTT patients compared to healthy controls. There was an apparent decrease in plasma iron in these patients. Degree of decline in zinc (p<0.001) was much greater than that of copper (p<0.04). Moreover, there was significant elevation of copper-zinc ratio and iron-zinc ratio (p<0.001) in BTT patients compared to controls. Both HbA1 and HbA2 correlated positively with both copper and iron. Interestingly, HbF showed negative correlation with all the three trace elements in BTT patients.Conclusion: The study highlights marked deficiency of plasma trace elements, hence, the need for periodic assessment and prompt administration of these micronutrients to reduce the complications in BTT patients. Further, ratios are more valuable markers in the determination of trace element status than individual elements.
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