31Dec 2016

LUMBOSACRAL BONE DENSITOMETRY IN CHILDREN WITH B-THLASSEMIA MAJOR.

  • M,B,Ch,B.,CABP,MSc., Department of Pediatrics, College of Medicine, University of Kufa, AlZahraa teaching hospital, Najaf, Iraq.
  • Ass.Professor of pediatrics Department of Pediatrics, College of Medicine, University of Kufa, AlZahraa teaching hospital, Najaf, Iraq .
  • Professor of pediatrics Department of Pediatrics, College of Medicine, University of Kufa, AlZahraa teaching hospital, Najaf, Iraq.
  • Ass. Professor of pediatrics FICMS,CABP.
Crossref Cited-by Linking logo
  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Background: Skeletal changes and bone complications in patients with beta thalassemia major are common and risky. We aim in this study to early detection of low bone density in children with thalassemia major thus overcome any asymptomatic skeletal changes and pathological fractures. The methods: this study is a cross sectional conducted in the center of hereditary blood disorders in alzahra teaching hospital for the period between 1st of October 2011 to end of November 2012. Fifty, randomly selected (selecting one patients every five of them) beta thalassemia major patients from a total of ( 685 patients) registered in the centre were evaluated for bone marrow densitometry ( BMD). Patients were classified according to their ages in 3 main groups , group A ( 2 – 5 yr) , group B ( 6 – 10 yr) and group C ( 11 – 15 yr ) . Dual energy x-ray absorptiometry ( DEXA) was performed in lumbar regions of those patients . The Z-scores were measured from bone density values according to age and gender. The Z score less than -2.5 was taken as cut off value for osteoporosis, and between -1 and -2.5 as osteopenia. Biochemical and hormonal parameters were recorded and analyzed Results: The patient age mean was ( 15 ± 5.5 years ) and BMD mean of spine was ( - 2.6500 +/- 0.9 ). Mean Hb. Was ( 9.01g/dl) . All groups of patients with high serum Ferritin level , and (10 %) with hypocalcemia , (26%) had hypophosphatemia , (38 % ) with high alkaline phosphates enzyme level. BMD was low in all patients of groups C ( 100% ) , (77.78 %) of group B and (52.63 %) of group A ( p = 0.048 ) , there is a significant relation between high levels of serum ferritin and BMD ( p = 0.0046 ) While there is no significant relation between S.Ca , S.Ph. , S.ALP level and BMD . Conclusion: present study show that patient of beta thalassemia major may show evidence of low BMD even in younger age group , and

  1. Edwar J.Hemoglobin variant Associated with Hemolytic Anemia , Altered Oxygen Affinity , And methmoglobinemias In : Hematology : Basic principles and practice , 3rd ed , Philadelphia , Churchill Living Stone, 2000 : 531 -532.
  2. Mentzer W. Thalassemia syndrome. In Rudolph's A, Hoffman J, Rudolph's C (eds). Rudolph's Pediatrics 20th Prentice Hall International, INC. United State of America , 1996 : 1209-1210.ss
  3. Chan YI ,Li CK, Chu WC . Deferoxamine induced bone dysplasia in tha distal femur and patella of pediatric patients and young adult. AMJ Roentgenol. 2000; 1561 – 63
  4. Desanctis V , Savarino L , Stea S . microstructural analysis of sever bone lesions in seven thalassemic patients treated with deferoxamine . Calcif tissue Int 2000 ; 40 :796-98.
  5. Vogel M , Anderson LJ , Holden S , Deanfield JE , Pennell DJ , Walker JM. Tissue Doppler echocardiography in patient with thalassemia detect early myocardial dysfunction related to myocardial iron overload. Eur Heart J 2003; 24 : 113-19.
  6. Cazzola M , Borgna-Pignatti C , Locatelli F, Ponchio L , Beguin Y , De Stefano P . A moderate transfusion regimen may reduce iron loading in beta-thalassemia major without producing excessive expansion of erythropoiesis. Transfusion 1997 ; 37 : 135.
  7. Karvounis HI, Zaglavara TA , Parharidis GE , Nouskas IG , Hassapopoulou EP , Gemitzis KD , Louridas GE . An angiotensin -converting enzyme inhibitor improves left ventricular systolic and diastolic function in transfusion dependent patients with beta-thalassemia major . Am Heart J 2001; 141: 281.
  8. Anand IS , Chandrashekhar Y , Ferrari R , Poole- Wilson PA, Harris PC . Pathogenesis of oedema in chronic sever anemia: study of body water and sodium , renal function , haemodynamic variables, and plasma hormones. Br Heart J 1993 ; 70 : 357-58.

9.       National Osteoporosis Foundation - Bone Mass         Measurement". Archived from the original on 2008-03-07. Retrieved 2008-03-20.

  1. Borgna-Pignatti C. Thalassemia. A few new tiles in a large mosaic.     2006; 91: 1159-61.
  2. Pagana, Kathleen Deska. Mosby's Manual of Diagnostic and Laboratory Tests. St. Louis: Mosby, Inc., 1998.
  3. Kroger H, Kotaniemi A, Vainio P, et al. Bone densitometry of the spine and femur in children by dual-energy x-ray absorptiometry. Bone Miner 1992;17:75–85.
  4. Jensen CE, Tuck SM, Agnew JE, et al. High prevalence of low bone mass in thalassemia major. Br J Hematol. 1998;103(4):911–5.
  5. Rund D, Rachmilewitz E. Thalassemia major–older patients, new Blood Rev. 1995;9:25–32.
  6. Voskaridou E, Terpos E. New insights into the pathophysiology and management of osteoporosis in patients with ?–thalassemia. J Hematol. 2004;127(2):127–39.
  7. Karimi M, Ghiam AF, Hashemi A, et al. Bone mineral density in beta thalassemia major and intermedia. Indian Pediatr.2007;44:29–32.
  8. Benigno V, Bertelloni S, Giampiero I, et al. Effects of thalassemia major on bone mineral density in late adolescence. J Pediatr Endocrinol Metab. 2003;16:337–42.
  9. Gratwick, G.M., Bullough, P.G., Bohne, W.H., Markenson, A.L., Peterson, C.M. (1978) Thalassemic osteoarthropathy. Annals of Internal Medicine, 88; 494501.
 

[Qasim M H Almosawi, Raid M R umran, Alaa Jumaah Nasrawi, Jasim Mohammed Hashim and Aymen A. Al-bakaa. (2016); LUMBOSACRAL BONE DENSITOMETRY IN CHILDREN WITH B-THLASSEMIA MAJOR. Int. J. of Adv. Res. 4 (Dec). 1657-1662] (ISSN 2320-5407). www.journalijar.com

Qasim M H Almosawi
Department of Pediatrics, College of Medicine, University of Kufa, AlZahraa teaching hospital, Najaf, Iraq

DOI:

Article DOI: 10.21474/IJAR01/2567      
DOI URL: http://dx.doi.org/10.21474/IJAR01/2567

Download Full Paper

Download PDF No. of Downloads: 11 | No. of Views: 75