Evaluation of lipoprotein-associated phospholipase a2 and cystatin c levels, and cartoid intima-media thickness in patients diagnosed with beta thalassemia major

Despite its rare occurance, beta thalassemia major is a significant health problem all around the world, which requires delicate treatment and follow-up with high costs. Most of the patients lose their life in the second decade due to treatment related complications. Patients might suffer cardiac, hepatic and endocrin organ dysfunction due to aggregation of iron in tissues and organs. We decided to make this study since especially cardiac arrest may seriously affect life functions. In order for early detection of changes in cardiovascular system caused by complications and periodic blood transfusion in beta thalassemia major patients we follow in our hospital; we aimed at evaluating Lp-PLA2 (lipoprotein-associated phospholipase A2) and Cys-C (Cystatin C) levels, which are proposed to be indicators of cardiovascular diseases in various recent studies, and also comparing these values with carotid intima-media thickness. Material and Method: The study group consisted of 30 patients with beta thalassemia major diagnosis who are being followed and included in blood transfusion program in Yüzüncü Yıl University Medical School Pediatric Health and Diseases Department's Pediatric Hematology and Oncology Unit; and the control group consisted of 30 patients with no chronic disease who applied to Yüzüncü Yıl University Medical School Pediatric Health and Diseases Department's General Pediatric Clinic. The study and the control groups were analyzed prospectively. Blood samples were collected from the study group before transfusion and CIMT (carotid intima-media thickness) values were measured. Blood samples were collected from the control group immediately after their application and CIMT values were also measured. Findings: 30 patients and 30 healthy children were included in our study. Average age was 8.07±4.03 years in the patient group while 11.03±3.99 years in the control group, and there was statistically significant difference between the groups in that regard (p<0.05). CSD (carotid artery systolic diameter) and PSV (peak systolic velocity) were significantly higher in the patient group compared to the control group (p: 0.029, p: 0.003 respectively). CAS (0.115±0.049) and CAD (10.08±5.28) were significantly lower in the patient group when compared to the control group (CAS: 0.148±0.035 and CAD: 13.53±4.93) (p: 0.004, p: 0.011 respectively). Although CIMT and CDD (carotid artery diastolic diameter) were higher in the patient group compared to the control group, there was no statistically meaningful difference (p>0.05). Although lipoprotein-associated phospholipase A and cystatin C levels were higher in the patient group compared to the control group, the difference was not statistically meaningful (average Lp-PLA2: 4.1 ng/mL for the patient group, average Lp-PLA2: 3.4 ng/mL for the control group, p: 0.164; average Cys-C: 3.5 ng/mL for the patient group, average Cys-C: 2.7 ng/mL for the control group, p: 0.137). Hemoglobin was meaningfully lower and ferritin was meaningfully higher in the patient group compared to the control group (p<0.05). TG was meaningfully higher in the patient group compared to the control group (p<0.05). TC, LDL and HDL were meaningfully lower in the patient group compared to the control group (p<0.05). Conclusion: There might be damage in the cardiovascular system due to disease-related complications and periodic blood transfusion in beta thalassemia major patients. In these patients, CAS and CAD values in the early period, and CIMT in later periods might be considered as indicators for cardiovascular damage. Our findings may be guiding for further large-scale studies in that field.