The relationship between antropometric values and insulin like growth factor-1, insulin like growth factor binding protein-3 and ferritin in thalassemia major patients

AIM: Growth and developmental deficiency that depend on chronic transfusion is observed in endocrine organs due to increasing body iron toxicity in beta-thalassemia. This study has been planned for studying effects of chronic iron toxicity on growth and development of beta-thalassemia patients. It was intended to examine the relationship between antropomethric values of patients and the values such as insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), ferritin and serum iron levels.METHOD: Fifty patients that were under control and taking transfusion because of beta-thalassemia major ( Group I: Transfusion duration> 5 years, Group II: Transfusion duration: 2-5 years) were included in this study. Twenty-five healthy individuals were selected as the control group. Weight, height, body mass index (BMI), height z-score values of three groups were calculated. Also IGF-1, IGFBP-3, ferritin, iron, and hemoglobin levels of Group I and Group II cases were measured.FINDINGS: Average values of BMI and height z-score of three groups were tested by ANOVA. There was no statistically significant difference in accordance with average values of BMI (p> 0.05) . But the difference between height z-score values was statistically significant ( 6.21 p=0.18) and the source of that difference was analyzed by Benferroni which is one of the Post Hok test. As a result of this analysis there was no important difference between Group-I and Group-II (p = 0,636), but there was an important difference between Group-I and Group-III also between Group-II and Group-III (respectively p < 0.001, p=0.006).Average IGF-1, IGFBP-3, ferritin and iron levels of Group I and Group II cases were analysed by Student?s t test. Average IGF-1 and IGFBP-3 levels of Group I were lower than average levels of Group II. This data was statistically significant (p< 0.05). Average Ferritin and iron levels of group I were higher than the levels of Group II and the difference between ferritin levels was statistically significant( p<0.05) but the diffence between iron levels was not (p=0.67).The datas of Group I and Group II were correlated by Pearson test. It was found out negatif & significant correlation between the duration of transfusion and IGFBP-3 and positive & significant correlation between the duration of transfusion and ferritin (respectively r = -0,28 p= 0,04 and r =0,55 p=0,001CONCLUSION: For the cases included in the study, the value of height z-scores were lower in the transfusion taken patients. IGF-I, IGFBP-3 variables were detected as lower for the long-term transfusion taken group. This result shows the negative effects of chronic iron toxicity on the growth hormone mediators. Also, the result is supported by the negative correlation between transfusion duration and IGFBP-3. Positive correlation between transfusion duration and ferritin indicates that the accumulation of iron in thalassemia patients constitutes a severe risc of disfunction in endocrin organs. For patients with thalassemia more disciplined and effective chelation treatment needs to be done. In our study negative correlation was detected between chelation duration and height z-score too. This result may be showing the adverse effects of iron chelators on growth and development. As a result, in the selected cases of thalassemi major with short stature, it was shown that the growth hormone can be used as a treatment option.Key words: Beta-talasemi major, insulin like growth factor-1, insulin like growth factor binding protein-3, ferritin, height z-score