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271 592 1 SM
271 592 1 SM
Research
Masters Program in Public Health, Universitas Sebelas Maret
ABSTRACT
Background: Thalassemia is a blood disease were iron deferiprone and deferasirox. Plasma
characterized by the most frequently found auto- zinc levels were measured by atomic absorption
somal recessive hereditary hemolytic anemia. It spectroscope. The data were analyzed by t test.
requires repeated blood transfusions for life. Results: Zinc levels in patients with deferiprone
Routine blood transfusion can cause complica- therapy (Mean= 54.50; SD= 11.02) were lower
tions in the form of accumulation of ferritin in than deferasirox therapy (Mean= 60.95; SD=
the tissue. Iron chelation therapy is considered
20.71), but statistically not significant (p= 0.229).
effective for treating body iron deposits. How-
ever, iron chelation therapy has the side effect of Conclusion:Zinc levels in patients with deferi-
decreasing levels of other important minerals prone therapy are lower than deferasirox therapy,
such as zinc (Zn). This study aimed to examine but not statistically significant.
plasma zinc difference in children with Thalasse-
mia β major received deferiprone or deferasirox Keywords: zinc, deferiprone, deferasirox,
zinc. children with thalassemia β major
Subjects and Method: This was a cross sec-
tional study conducted at Dr. Moewardi Hospital, Correspondence:
Surakarta, from February to April 2017. A sample Wahyu Kusumawardhani. Department of Pedia-
of 40 children with thalassemia β major aged 3 to trics, Faculty of Medicine, Universitas Sebelas
18 years who received deferiprone iron chelation Maret/ Dr. Moewardi Hospital, Surakarta, Cen-
and deferasirox at least 6 months was selected by tral Java. Phone/ Fax: 0271-633348. Email: dha-
consecutive sampling. The dependent variable nisuryadiraja@gmail.com
was serum zinc levels. The independent variables
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Kusumawardhani et al / Plasma zinc difference in children with thalassemia β major
Table 3. Differences in zinc levels by type of Deferasirox iron chelation therapy with
Deferiprone therapy
Flatfoot Iron Mean SD p
Deferasirox 54.50 60.95 0.229
Deferiprone 11.02 20.71
Table 3 shows that zinc levels in pati- Table 4 shows that there were almost
ents on deferasirox therapy (Mean= 54.50; no differences in levels of Defasirox or
SD= 11.02) are lower than deferiprone thera- Deferiprone iron chelation based on the
py (Mean= 60.95; SD= 20.71), but statisti- amount of blood transfusion.
cally not significant (p= 0.229).
Table 4. Differences in Zinc Levels Based on Iron Flatfoot and Blood Transfusion
Flatfoot And Transfusion n Mean SD p
Deferasirox-1 bag 8 56.13 13.86 0.722
Deferasirox-2bags 11 53.00 9.51
Deferasirox-3bags 1 58.00 <0.01
Deferasirox-1 bag 4 65.25 15.35
Deferiprone-2bags 14 61.29 23.36
Deferiprone-3bags 2 50.00 5.66
Table 6 shows zinc levels in patients with (Mean= 54.29; SD= 16.59) but statistically
good nutritional status (Mean= 60.26; SD= not significant (p= 0.180).
16.68) higher than poor nutritional status
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Kusumawardhani et al / Plasma zinc difference in children with thalassemia β major
Zinc levels did not differ significantly treated with iron chelation. A study with pre
with each transfusion bag and iron chelation. and post test evaluation methods is also
A study states that the administration of needed to be able to evaluate differences in
blood transfusion can significantly increase laboratory value parameters such as zinc,
serum zinc levels (Kizilgun et al., 2016). This ferritin, GDS, SGOT, SGPT before and after
is thought to be caused by the effect of Defe- iron chelation is given.
rasirox and Deferiprone iron chelating agents Based on the results, it can be conclu-
which are equally strong in reducing zinc ded that there is an influence between the ad-
levels in patients, so the differences between ministration of iron chelation on zinc, GDS,
groups become insignificant (Zekavat et al, SGOT, SGPT, and ferritin levels. There are
2018). However, it is suspected there are also significant differences between Ferro-
other reasons that cause this insignificant siprox and Deferasirox chelation on serum
difference. First, the distribution of respon- levels of GDS, SGOT, and SGPT, but not on
dents was uneven in several groups. Each zinc and ferritin levels. In addition, the
group does not consist of the same number of patient's nutritional status is not related to
respondents, so it will affect the average of zinc levels in the patient.
each group. Secondly, the presence of zinc
intake in the respondents' diet is thought to AUTHOR CONTRIBUTION
have influenced the results of serum zinc Wahyu Kusumawardhani was the main
levels. Respondents with lower zinc con- author in this study, measured plasma zinc
sumption will have lower serum zinc levels, level, wrote the manuscript. Harsono Salimo
and are more at risk of developing growth and Muhamad Riza interpreted the results of
disorders during the course of thalassemia study.
(Fung, 2016).
4. The nutritional status in children CONFLICT OF INTEREST
with thalassemia β Major There was no conflict of interest in this study.
The results showed that nutritional status
was not significantly related to serum zinc FUNDING AND SPONSORSHIP
levels in patients. However, based on several This study was self-funded
existing studies, there is a relationship
between nutritional status and serum zinc ACKNOWLEDGEMENT
levels (Fung, 2016; Kulathinal et al., 2016). The author would like to thank all those who
This is likely because the nutritional status of have helped this research, to the patients and
the patient is measured by measuring the parents of the study subjects, Head of Room
upper arm circumference. A study states that and Nurse of Melati 2 Room, Clinical Patho-
the measurement of nutritional status by the logy Laboratory Dr. Moewardi Surakarta, and
waist circumference method shows a signi- all those who helped in this research.
ficant relationship to serum zinc levels in
respondents (Kulathinal et al, 2016). REFERENCE
Limitation of this study is the absence Hagag AA, Elfaragy MS, Elrifaey SM, Abd El-
of respondents who act as controls in the Lateef AE (2015). Therapeutic value of
study. The control meant were respondents combined therapy with deferiprone
with beta thalassemia who did not undergo and silymarinas iron chelators in Egyp-
blood transfusion and iron chelation therapy, tian children with beta thalassemia
or who did blood transfusion but were not major. Infect Disord Drug Targets,
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