Assessment of Serum Folic Acid and Homocysteine in Thalassemia Major Patients Before and After Folic Acid Supplement Cessation

Baghersalimi, Adel; Kolachahi, Hajar Hemmati; Darbandi, Bahram; Mavardiani, Zahra Kamran; Alinodehi, Maryam Alizadeh; Dalili, Setila; Rad, Afagh Hassanzadeh

doi:10.1097/mph.0000000000001295

Cited by 5 publications

(4 citation statements)

References 20 publications

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“…19 No changes in erythrocyte parameters were observed. Of interest, Baghersalimi et al 34 reported that in Thal patients taking clinically prescribed folate supplements (1 mg/d) for a minimum of 6 months, cessation of supplement use led to significantly increased serum homocysteine, and decreased serum folic acid.…”

Section: Folatementioning

confidence: 99%

Nutrition in Thalassemia: A Systematic Review of Deficiency, Relations to Morbidity, and Supplementation Recommendations

Goldberg¹,

Lal

Fung

2021

Journal of Pediatric Hematology/Oncology

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Background: Reports of nutritional deficiencies in patients with thalassemia (Thal) are common. Despite its importance, however, nutritionally focused research in Thal has been limited by inadequate sample size, inconsistent methodology, a lack of control comparisons, and few interventional trials. Due to these limitations, clinicians lack evidence-based nutrition recommendations to support clinical decision-making. This systematic review summarizes observed relationships between nutrition and morbidity in Thal published in the last 3 decades.Methods: PubMed, Web of Science, and Embase were screened for articles pertaining to nutrition in Thal using comprehensive search terms. Studies performed in humans, written in English, and published between 1990 and 2020 were included. Over 2100 manuscripts were identified, from which 97 were included.Results: Patients with Thal were most often deficient in vitamins A, C, D, selenium, and zinc. Prevalence of nutritional deficiency was positively correlated with age and iron overload. Evidence to support the role of vitamin D and zinc for bone health was observed; zinc was also found to improve glucose metabolism.Conclusions: Due to the risk for multinutrient deficiency, nutritional status should be assessed annually in patients with Thal with prompt nutrient replacement when deficiency is detected. Routine supplementation with vitamin D and zinc is recommended.

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Section: Folatementioning

confidence: 99%

Nutrition in Thalassemia: A Systematic Review of Deficiency, Relations to Morbidity, and Supplementation Recommendations

Goldberg¹,

Lal

Fung

2021

Journal of Pediatric Hematology/Oncology

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“…Iron chelation therapy, which is used in β-TM to reduce IO, is widely used to prevent the consequences of IO on heart, liver, bones, and immune system [21] but is usually associated with many adverse effects including infections [9,22]. Some clinicians propose that treatment with vitamin C and folic acid in TM patients may improve erythropoiesis and the secondary deficiencies in these vitamins [23,24]. The iron status in β-TM patients undergoing blood transfusions can be monitored by noninvasive methods including measurements of serum iron (Fe), which is distributed within the body via plasma transferrin (Tf), a transport protein that mediates iron exchange between tissues, total iron-binding capacity (TIBC), Tf levels, Tf saturation percentage (TS%), unsaturated iron-binding capacity (UIBC) and ferritin levels [25].…”

Section: Introductionmentioning

confidence: 99%

Major Depression in Children with β-Thalassemia Major is Strongly Associated with the Number of Blood Transfusions, Iron Overload and Increased Levels of Interleukin-1β

Al‐Hakeim¹,

Najm²,

Al-Aldujaili³

et al. 2019

Preprint

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Beta-thalassemia major (β-TM) patients are treated with repeated blood transfusions, which may cause iron overload (IO), which in turn may induce immune aberrations. Patients with β-TM have an increased risk of major depressive disorder (MDD). The aims of the present study are to examine whether repeated blood transfusions, IO and immune-inflammatory responses are associated with MDD in children (6-12 years) with β-TM. The Children’s Depression Inventory (CDI), iron status (serum iron, ferritin, transferrin, TS%) and serum levels of CCL11, IL-1β, IL-10, and TNF-α were measured in β-TM with (n=54) and without (n=57) MDD and in healthy children (n=55). The results show that MDD in β-TM is associated with a greater number of blood transfusions, increased IO and IL-1β levels. Partial Least Squares path analysis shows that 68.8% of the variance in the CDI score is explained by the number of blood transfusions, IO, and increased levels of IL-1β and TNF-α. The latter two cytokines partly mediate the effects of IO on the CDI score, while the effects of blood transfusions on the CDI score are partly mediated by IO and the path from IO to immune activation. IO is also associated with increased IL-10 and lower CCL11 levels but these alterations are not significantly associated with MDD. In conclusion, blood transfusions may be causally related to MDD in β-TM children and their effects are in part mediated by increased IO and the consequent immune-inflammatory response. The results suggest that not only IO and its consequences including inflammation and ferroptosis, but also other factors related to the number of transfusions may cause MDD including psychosocial stressors. Current treatment modalities with folic acid and vitamin C are insufficient to attenuate IO and immune-inflammatory responses and to prevent MDD is children with β-TM undergoing blood transfusions.

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“…In the first reaction, Hcy is converted to methionine by using cobalamin as cofactor. Cobalamin deficiency results in the accumulation of Hcy that induce lipid peroxidation and generate free radicals, resulting in endothelial dysfunction 2,3. Hyperhomocysteinemia and low vitamin B 12 concentration play an essential role in endothelial damage and are independent risk factors for CVD in adult patients with coronary artery disease 4.…”

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confidence: 99%

“…Cobalamin deficiency results in the accumulation of Hcy that induce lipid peroxidation and generate free radicals, resulting in endothelial dysfunction. 2,3 Hyperhomocysteinemia and low vitamin B 12 concentration play an essential role in endothelial damage and are independent risk factors for CVD in adult patients with coronary artery disease. 4 Also, severe acquired vitamin B 12 deficiency could lead to a condition that mimics thrombotic microangiopathies.…”

mentioning

confidence: 99%

Endothelium-derived Microparticles Are Increased in Teenagers With Cobalamin Deficiency

Dündar

Torun²,

Cetin³

et al. 2021

Journal of Pediatric Hematology/Oncology

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Introduction: Vitamin B12 (cobalamin) deficiency may be a significant cause of hyperhomocysteinemia, and high homocysteine (Hcy) levels are associated with an increased risk of cardiovascular disease. Endothelium-derived microparticles (EMPs) are a new marker in endothelial dysfunction and atherosclerosis, which play a role in cardiovascular diseases’ pathogenesis. This study aimed to evaluate the EMPs, the markers of endothelial dysfunction and atherosclerosis, and lipid profile in teenagers with cobalamin deficiency. Materials and Methods: This prospective study included 143 teenagers, 75 vitamin B12 deficient patients and 68 healthy controls between 11 and 18 years of age. Routine laboratory tests, hemogram, vitamin B12, folic acid, ferritin, Hcy, lipid profile and EMPs were examined and compared. EMP subgroups were analyzed by flow cytometry method according to the expression of membrane-specific antigens. The microparticles released from the endothelium studied were VE-cadherin (CD144), S-endo1 (CD146), and Endoglin (CD105). Results: The present study demonstrates that circulating CD105+ EMP, CD144+ EMP, CD146+ EMPs, and Hcy were increased, and high-density lipoprotein (HDL) cholesterol was reduced in teenagers with cobalamin deficiency. Vitamin B12 showed a negative correlation with EMPs and Hcy, positive correlation with folate and HDL. All EMPs showed a significant positive correlation with triglyceride, vitamin B12, and HDL. Conclusion: Vitamin B12 deficiency may predispose to endothelial damage and atherosclerosis by increasing EMPs and harms lipid metabolism in the long term.

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Assessment of Serum Folic Acid and Homocysteine in Thalassemia Major Patients Before and After Folic Acid Supplement Cessation

Cited by 5 publications

References 20 publications

Nutrition in Thalassemia: A Systematic Review of Deficiency, Relations to Morbidity, and Supplementation Recommendations

Nutrition in Thalassemia: A Systematic Review of Deficiency, Relations to Morbidity, and Supplementation Recommendations

Major Depression in Children with β-Thalassemia Major is Strongly Associated with the Number of Blood Transfusions, Iron Overload and Increased Levels of Interleukin-1β

Endothelium-derived Microparticles Are Increased in Teenagers With Cobalamin Deficiency

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Assessment of Serum Folic Acid and Homocysteine in Thalassemia Major Patients Before and After Folic Acid Supplement Cessation

Cited by 5 publications

References 20 publications

Nutrition in Thalassemia: A Systematic Review of Deficiency, Relations to Morbidity, and Supplementation Recommendations

Nutrition in Thalassemia: A Systematic Review of Deficiency, Relations to Morbidity, and Supplementation Recommendations

Major Depression in Children with &beta;-Thalassemia Major is Strongly Associated with the Number of Blood Transfusions, Iron Overload and Increased Levels of Interleukin-1&beta;

Endothelium-derived Microparticles Are Increased in Teenagers With Cobalamin Deficiency

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Major Depression in Children with β-Thalassemia Major is Strongly Associated with the Number of Blood Transfusions, Iron Overload and Increased Levels of Interleukin-1β