Raghuwanshi Babita, Kumari Suchitra, Sahoo Durgesh Prasad
Department of Transfusion Medicine and Blood Bank, AIIMS, Bhopal, Madhya Pradesh, India.
Department of Biochemistry, AIIMS Bhubaneswar, Odisha, India.
J Family Med Prim Care. 2020 Feb 28;9(2):973-977. doi: 10.4103/jfmpc.jfmpc_845_19. eCollection 2020 Feb.
The transfusions in patients with thalassemia are a double-edged sword as the patients develop complications due to inadequate transfusions and due to multiple transfusions. These complications vary from metabolic complications such as diabetes mellitus and clinical complications such as growth retardation, transfusion-transmitted infections (TTI), and iron overload. We selected Balasore district in Odisha which is a satellite center of AIIMS Bhubaneshwar and has a huge population of hemoglobinopathy patients especially thalassemia and this district in Odisha lags in terms of healthcare and health awareness.
In all, 123 patients with thalassemia major were included in this study for the evaluation of metabolic and clinical complications. Anthropometric measurements such as height and weight with age and gender were used for evaluation of growth parameters as per World Health Organization (WHO) reference data. Children were termed wasted and stunted if the values were below 2 standard deviation of the reference WHO median. Blood samples were collected for TTI status and fasting blood sugar levels.
A total of 118 (95.9%) were detected to have under nutrition, 73 (59.3%) of the patients were HCV-positive, and 54 (48.6%) had high fasting blood sugar levels. Based on the HCV status, they were classified as HCV-positive and HCV-negative to compare the anthropometric and growth status in these patients. About 98.6% of the HCV-positive cases were undernutrition and 83.6% were stunted.
There is an increasing trend of associated metabolic derangements in patients with thalassemia. The district-level health services have an urgent need for improvement in chelation regimes and screening technologies.
地中海贫血患者输血是一把双刃剑，因为患者会因输血不足以及多次输血而出现并发症。这些并发症包括代谢并发症，如糖尿病，以及临床并发症，如生长发育迟缓、输血传播感染（TTI）和铁过载。我们选择了奥里萨邦的巴拉索尔地区，该地区是布巴内什瓦尔全印医学科学研究所的卫星中心，有大量血红蛋白病患者，尤其是地中海贫血患者，而且奥里萨邦的这个地区在医疗保健和健康意识方面较为落后。
本研究共纳入123例重型地中海贫血患者，以评估其代谢和临床并发症。根据世界卫生组织（WHO）的参考数据，使用身高、体重等人体测量指标以及年龄和性别来评估生长参数。如果数值低于WHO参考中位数的2个标准差，则儿童被判定为消瘦和发育迟缓。采集血样检测TTI状况和空腹血糖水平。
总共检测出118例（95.9%）存在营养不良，73例（59.3%）患者丙肝病毒呈阳性，54例（48.6%）空腹血糖水平较高。根据丙肝病毒感染状况，将患者分为丙肝病毒阳性和丙肝病毒阴性，以比较这些患者的人体测量和生长状况。约98.6%的丙肝病毒阳性病例存在营养不良，83.6%发育迟缓。
地中海贫血患者并发代谢紊乱的趋势呈上升态势。地区级卫生服务机构迫切需要改进螯合疗法和筛查技术。
