Comparison of serum homocysteine levels in transfusion-dependent β-thalassemia patients with regular and irregular folic acid supplementation
DOI:
https://doi.org/10.18203/2320-6012.ijrms20261332Keywords:
β-thalassemia, Folic acid adherence, Transfusion-dependent thalassemiaAbstract
Background: Transfusion-dependent β-thalassemia (TDT) patients have increased folate requirements due to chronic erythropoietic stress. Inadequate folate intake may result in elevated serum homocysteine, a recognized risk factor for vascular complications. This study aimed to compare serum homocysteine levels between TDT patients with regular and irregular folic acid supplementation and to assess correlations with duration of supplementation and age.
Methods: This cross-sectional comparative study was conducted at the Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, between March 2023 and February 2024. Forty TDT patients were categorized into regular (n=20) and irregular (n=20) folic acid supplementation groups. Fasting serum homocysteine levels were measured using chemiluminescent immunoassay. Data were analyzed using SPSS version 27.0.
Results: Mean serum homocysteine was significantly lower in the regular supplementation group (5.19±1.04 µmol/l) compared with the irregular group (13.68±5.47 µmol/l; p<0.001). Hyperhomocysteinemia (≥15 µmol/l) was observed exclusively among irregularly supplemented patients (30%). A negative correlation was identified between duration of supplementation and homocysteine level, while age showed a modest positive trend with homocysteine among irregular users.
Conclusions: Irregular folic acid supplementation is associated with significantly elevated serum homocysteine levels in transfusion-dependent β-thalassemia patients. Sustained adherence to supplementation may reduce metabolic risk and should be emphasized in routine clinical management.
References
Rund D, Rachmilewitz E. β-Thalassemia. New England J Med. 2005;353(11):1135-46.
Sleiman J, Tarhini A, Bou-Fakhredin R, Saliba AN, Cappellini MD, Taher AT. Non-transfusion-dependent thalassemia: an update on complications and management. Int J Mol Sci. 2018;19(1):182.
Borgna C, Galanello R. Thalassemias and related disorders: quantitative disorders of hemoglobin synthesis. In Wintrobe's Clinical Hematology 3° ED Lippincott Williams & Wilkins. 2009: 1083-113.
Gluba-Brzózka A, Franczyk B, Rysz-Górzyńska M, Rokicki R, Koziarska-Rościszewska M, Rysz J. Pathomechanisms of immunological disturbances in β-thalassemia. Int J Mol Sci. 2021;22(18):9677.
Thuret I, Ruggeri A, Angelucci E, Chabannon C. Hurdles to the adoption of gene therapy as a curative option for transfusion-dependent thalassemia. Stem Cells Transl Med. 2022;11(4):407-14.
Baghersalimi A, Kolachahi HH, Darbandi B, Mavardiani ZK, Alinodehi MA, Dalili S, et al. Assessment of serum folic acid and homocysteine in thalassemia major patients before and after folic acid supplement cessation. J Pediat Hematol/Oncol. 2018;40(7):504-7.
Abd-Elmawla MA, Rizk SM, Youssry I, Shaheen AA. Impact OF GENETIC POLYMORPHISM OF METHYLENETETRAHYDROFOLATE REDUCTASE C677T on development of hyperhomocysteinemia and related oxidative changes in egyptian β-thalassemia major patients. PLoS One. 2016;11(5):155070.
Musallam KM, Bou‐Fakhredin R, Cappellini MD, Taher AT. 2021 update on clinical trials in β‐thalassemia. American J Hematol. 2021;96(11):1518-31.
Demosthenous C, Vlachaki E, Apostolou C, Eleftheriou P, Kotsiafti A, Vetsiou E, et al. Beta-thalassemia: renal complications and mechanisms: a narrative review. Hematology. 2019;24(1):426-38.
Al Akhras A, Badr M, El Safy U, Kohne E, Hassan T, Abdelrahman H, et al. Impact of genotype on endocrinal complications in β thalassemia patients. Biomedical reports. 2016;1;4(6):728-36.
Finkelstein JD. The metabolism of homocysteine: pathways and regulation. European J Pediat. 1998;157(2):40-4.
Selhub J. Homocysteine metabolism. Annual review of nutrition. 1999;19(1):217-46.
Hankey GJ, Eikelboom JW. Homocysteine and vascular disease. The lancet. 1999;354(9176):407-13.
Taher AT, Otrock ZK, Uthman I, Cappellini MD. Thalassemia and hypercoagulability. Blood reviews. 2008;22(5):283-92.
Rahman SA, Jamal CY. Subjects and methods. Indian Pediat. 2002;39:574-7.