Heart failure in the diagnosis and treatment in children with iron deficiency anemia response follow the clinical significance of the level of serum nt-probnp

OBJECTİVESWe planned this research for identification of cardiac failure in children with iron deficiency anemi during the asymptomatic period, identifying the clinical importance of NT-proBNP as a biochemical marker and investigating whether there exists any significant association between Ross scoring for cardiac failure evaluation and NT-proBNP.MATERIAL AND METHODSThe study was held in Malatya İnönü University Pediatrics Department between may 2009 and july 2010. 96 pediatric age group patients who applied to the pediatrics polyclinics and diagnosed as iron deficiency anemia, aging between 10 months and 204 months were included in the study groups (group-1 and group-2). 42 healthy children applied to the pediatrics policlinics for control purposes were included in the control group (group-3). The study was held in prospective manner. 30 members of the study group were excluded from the group due to unability to fulfill the study criteria. 49 patients having no cardiac failure findings (group-1) were treated with oral iron supplements.17 patients manifesting cardiac failure based on the physical examinations (group 2) were treated with erythrocyte transfusions. Orally treated patient group (group-1) were called for control after 4-5. months from the beginning of the oral treatment. The patient group which erythrocyte transfusion were given (group-2) were called for control one week after the transfusion. NT-proBNP levels were examined before and after the treatment. Echocardiographic evaluations and Ross classification were done before and after the treatment.FINDINGSStudy groups consisted; Group 1: 22 (% 44,9) female, 27 (%55,1) male, Group 2: 11 (%64,7) female, 6 (%35,3) male patients. Group 3 consisted 26 (%61,9) female, 16 (%38,1) male healthy children. The mean age and standart deviations of the groups were; group 1: 61,9±67,2 months, group 2: 112,3±69,2 months, group 3: 81,7±37,7 months, Among the control group, NT-proBNP values were examined and no statistical significance based on the age and sex differences were found. The pre-treatment patient group NT-proBNP values and Hb levels showed statistically significant and inverse relation (p:0,004 r:-0,346). The patient group NT-proBNP levels before and after the treatment were evaluated; NT-proBNP level decrease in paralel with rise of Hb levels were noted. After treatment NT-proBNP levels were found to be similar with the control group (p:0,405). The patient group pre-treatment Ross scores and NT-proBNP levels showed significant positive linear correlation (p:0,015; r:0,299). Compared to the controls the pre-treatment patient group EF values were significantly higher. Pre-treatment EF, LVIDD and E/A ratios of the patient group and NT-proBNP levels were compared and no statistical significance were found.CONCLUSIONBased on our findings, in children with iron deficiency anemia, levels of NT-proBNP begin to rise earlier than the appearance of clinical findings and echocardographic definiton of cardiac failure. NT-proBNP measurement, a fast serological marker, may be used clinically for early definition and proper treatment of the cardiac failure in cases with iron deficiency anemia. Based on our findings, the benefits of the erythrocyte transfusion supplementation of the patients during the asymtmatic period are lower than the potential hazards.Key words: iron deficiency anemia, cardiac failure, NT-proBNP, child.