• Tariq Hamayun kmu


Background: Thalassemia syndrome represents a heterogeneous group of inherited anemias. It is one of the most common hereditary genetic disorders in Pakistan. Vita-min D is an important metabolite known to be deranged in various systemic illnesses involving kidneys, liver, GIT and endocrine system. Defective synthesis of 25-OH vi-tamin D have been described in these patients which negatively affect their bone

metabolism. Impaired calcium homeostasis is thought to be a consequence of iron overload seen in multi-transfused thalassemia patients. Objective of the study was to assess serum vitamin D and calcium levels in β thalassemia syndrome patients of district Peshawar.

Methodology: The current study had descriptive study design with cross-sectional time prospect. A total of 141 thalassemia syndrome patients were enrolled in the study. Physical examination was performed followed by collection of blood sam-ples. The samples were then processed and analyzed in the laboratories of Insti-tute of Basic Medical Sciences, Khyber Medical University, Peshawar.

Results: The mean age of our study group patients was 12.62+5.10 years. The mean 25-OH Vit D levels were 17.48+11.34 ng/dl, while mean total serum Ca con-centration was 8.67+9.1 mg/dl. Only 21.3% of our patients had optimal/normal levels of serum vitamin D concentration. 72.3% of our study patients had normal levels of their total serum calcium, while 27% of patients had low total serum calcium levels and 0.7% had high levels for serum calcium.

Conclusion: The present study showed a high prevalence of VDD and low total serum calcium levels in thalassemia patients with a significant low BMI, that signify the importance of screening for said metabolites and appropriate ther-apeutic interventions. The presence of such metabolic derangements may be due to the presence of high serum ferritin levels and poor nutrition intake.

Appropriate measurements therefore should be taken to improve heath and quality of life in thalassemia patients.


Shaimaa K. Ali HA, ‘Prevalence of Hypocalcemia among Thalassemic Patients Registred in Ibn Al-Balady Hospital ( Thalassemic Centre) Baghdad Iraq’, Tikrit Joumat of Phar-maceutical Sciences, 4(2):147’l5l (2008).

Syed Asad Ali, Rafe M. J. Donahue, Huma Qureshi, and Sten H. Vermund, ‘Hepatitis B and Hepatitis C in Pakistan: Prevalence and Risk Factors’, International Journal of In-fectious Diseases, 13 (2009), 9-19.

J. F. Aloia, J. A. Ostuni, J. K. Yeh, and E. C. Zaino, ‘Com-bined Vitamin D Parathyroid Defect in Thalassemia Ma-jor’, Arch Intern Med, 142 (1982), 831-2.

Ibrahim Aslan, Duran Canatan, Nihal Balta, Gulizar Kacar, Cengaver Dorak, Ahmet Ozsancak, Nurgul Oguz, and Ruya Cosan, ‘Bone Mineral Density in Thalassemia Major Pa-tients from Antalya, Turkey’, International Journal of En-docrinology, 2012 (2012), 4.

N Basha, Khalida Parveen, Beena Shetty, and U. V. Shenoy, ‘Prevalence of Hypoparathyroidism (Hpt) in Beta Thalas-semia Major’, Journal of Clinical and Diagnostic Research, 8 (2014), 24-26.

V. Benigno, S. Bertelloni, G. I. Baroncelli, L. Bertacca, S. Di Peri, L. Cuccia, Z. Borsellino, and M. C. Maggio, ‘Effects of Thalassemia Major on Bone Mineral Density in Late Ad-olescence’, J Pediatr Endocrinol Metab, 2 (2003), 337-42.

H. A. Bischoff-Ferrari, E. Giovannucci, W. C. Willett, T. Dietrich, and B. Dawson-Hughes, ‘Estimation of Optimal Serum Concentrations of 25-Hydroxyvitamin D for Multiple Health Outcomes’, Am J Clin Nutr, 84 (2006), 18-28.

M. Casale, S. Citarella, A. Filosa, E. De Michele, F. Palm-ieri, A. Ragozzino, G. Amendola, U. Pugliese, I. Tartagli-one, F. Della Rocca, P. Cinque, B. Nobili, and S. Perrotta, ‘Endocrine Function and Bone Disease During Long-Term Chelation Therapy with Deferasirox in Patients with Be-ta-Thalassemia Major’, Am J Hematol, 89 (2014), 1102-6.

L. H. Chow, J. V. Frei, A. B. Hodsman, and L. S. Valberg, ‘Low Serum 25-Hydroxyvitamin D in Hereditary Hemo-chromatosis: Relation to Iron Status’, Gastroenterology, 88 (1985), 865-9.

Soteroulla Christou, ‘Vitamin D Levels Correlate with Iron Load and Glycemic Intolerance inThalassemia’, Thalas-semia international fideration (2013).

H. F. DeLuca, ‘Overview of General Physiologic Features and Functions of Vitamin D’, Am J Clin Nutr, 80 (2004), 1689S-96S.

S. Domrongkitchaiporn, V. Sirikulchayanonta, P. Angchai-suksiri, W. Stitchantrakul, C. Kanokkantapong, and R. Rajatanavin, ‘Abnormalities in Bone Mineral Density and Bone Histology in Thalassemia’, J Bone Miner Res, 18 (2003), 1682-8.

Fahim M. Fahim, Khaled Saad, Eman A. Askar, Eman Nasr Eldin, and Ahmed F. Thabet, ‘Growth Parameters and Vita-min D Status in Children with Thalassemia Major in Upper Egypt’, International Journal of Hematology-Oncology and Stem Cell Research, 7 (2013), 10-14.

M. F. Holick, ‘High Prevalence of Vitamin D Inadequacy and Implications for Health’, Mayo Clinic Proceedings, 81 (2006), 353-73.

———, ‘Vitamin D Deficiency’, The New England Journal of Medicine, 357 (2007), 266-81.

Michael F. Holick, ‘The Vitamin D Epidemic and Its Health Consequences’, The Journal of Nutrition, 135 (2005), 2739S-48S.

E.Refatllari J.Zoga, ‘Level of Vitamin D in Patients Af-fected by ThalassemiaMajor and Sickle Cell Disease in the Center of Haemoglobinopathy Lushnja, Albania’, EDIS - Publishing Institution of the University of Zilina ,, 3 (2014), 229-32.

M. Karimi, F. Habibzadeh, and V. De Sanctis, ‘Hypopara-thyroidism with Extensive Intracerebral Calcification in Patients with Beta-Thalassemia Major’, J Pediatr Endocri-nol Metab, 16 (2003), 883-6.

S. N. Khan, and S. Riazuddin, ‘Molecular Characterization of Beta-Thalassemia in Pakistan’, Hemoglobin, 22 (1998), 333-45.

N. Koonrungsesomboon, S. C. Chattipakorn, S. Fucharoen, and N. Chattipakorn, ‘Early Detection of Cardiac Involve-ment in Thalassemia: From Bench to Bedside Perspec-tive’, World J Cardiol, 5 (2013), 270-9.

Elizabeth A. Krall, Nadine Sahyoun, Saul TannenbaumGerard E. Dallal, and Bess Dawson-Hughes, ‘Effect of Vi-tamin D Intake on Seasonal Variations in Parathyroid Hor-mone Secretion in Postmenopausal Women’, New England Journal of Medicine, 321 (1989), 1777-83.

A. Levin, G. L. Bakris, M. Molitch, M. Smulders, J. Tian,

L. A. Williams, and D. L. Andress, ‘Prevalence of Abnor-mal Serum Vitamin D, Pth, Calcium, and Phosphorus in Patients with Chronic Kidney Disease: Results of the Study to Evaluate Early Kidney Disease’, Kidney International, 71 (2006), 31-38.

P. Mahachoklertwattana, V. Sirikulchayanonta, A. Chuan-sumrit, P. Karnsombat, L. Choubtum, A. Sriphrapradang,

S. Domrongkitchaiporn, R. Sirisriro, and R. Rajatanavin, ‘Bone Histomorphometry in Children and Adolescents with Beta-Thalassemia Disease: Iron-Associated Focal Osteo-malacia’, J Clin Endocrinol Metab, 88 (2003), 3966-72.

Khaled M. Musallam, Maria Domenica Cappellini, John C. Wood, Irene Motta, Giovanna Graziadei, Hani Tamim, and Ali T. Taher, ‘Elevated Liver Iron Concentration Is a Marker of Increased Morbidity in Patients with Β Thalassemia In-termedia’, Haematologica, 96 (2011), 1605-12.

N. Napoli, Enrico Carmina, Salvatore Bucchieri, C. Sfer-razza, G. B. Rini, and G. Di Fede, ‘Low Serum Levels of 25-Hydroxy Vitamin D in Adults Affected by Thalassemia Major or Intermedia’, Bone, 38, 888-92.

O. Oliveros, F. Trachtenberg, D. Haines, E. Gerstenberger,

M. Martin, S. Carson, S. Green, D. Calamaras, P. Hess, R. Yamashita, and E. Vichinsky, ‘Pain over Time and Its Ef-fects on Life in Thalassemia’, Am J Hematol, 88 (2013), 939-43.

Salvatore Petta, Calogero Cammà, Concetta Scazzone, Claudio Tripodo, Vito Di Marco, Antonino Bono, Daniela Cabibi, Giusalba Licata, Rossana Porcasi, Giulio Marches-ini, and Antonio Craxí, ‘Low Vitamin D Serum Level Is Re-lated to Severe Fibrosis and Low Responsiveness to Inter-feron-Based Therapy in Genotype 1 Chronic Hepatitis C’, Hepatology, 51 (2010), 1158-67.

A. A. Shamshirsaz, M. R. Bekheirnia, M. Kamgar, N. Pour-zahedgilani, N. Bouzari, M. Habibzadeh, R. Hashemi, S. Aghakhani, H. Homayoun, and B. Larijani, ‘Metabolic and Endocrinologic Complications in Beta-Thalassemia Ma-jor: A Multicenter Study in Tehran’, BMC Endocr Disord, 3 (2003), 4.

Adil Sheikh, Zeb Saeed, Syed Ali Danial Jafri, Iffat Yazdani,and Syed Ather Hussain, ‘Vitamin D Levels in Asymptomat-ic Adults-a Population Survey in Karachi, Pakistan’, PLoS ONE, 7 (2012), e33452.

A. Soliman, A. Adel, M. Wagdy, M. Al Ali, and N. ElMulla, ‘Calcium Homeostasis in 40 Adolescents with Beta-Thal-assemia Major: A Case-Control Study of the Effects of In-tramuscular Injection of a Megadose of Cholecalciferol’, Pediatr Endocrinol Rev, 1 (2008), 149-54.

A. Soliman, A. Adel, M. Wagdy, M. Al Ali, and N. ElMulla, ‘Calcium Homeostasis in 40 Adolescents with Be-ta-Thalassemia Major: A Case-Control Study of the Effects of Intramuscular Injection of a Megadose of Cholecalcif-erol’, Pediatric Endocrinology Reviews, 6 Suppl 1 (2008), 149-54.

Ashraf Soliman, Vincenzo De Sanctis, and Mohamed Yas-sin, ‘Vitamin D Status in Thalassemia Major: An Update’, Mediterranean Journal of Hematology and Infectious Dis-eases, 5 (2013), e2013057.

T. G. St Pierre, P. R. Clark, W. Chua-anusorn, A. J. Flem-ing, G. P. Jeffrey, J. K. Olynyk, P. Pootrakul, E. Robins, and R. Lindeman, ‘Noninvasive Measurement and Imaging

of Liver Iron Concentrations Using Proton Magnetic Reso-nance’, Blood, 105 (2005), 855-61.

A. A. Tantawy, M. El Kholy, T. Moustafa, and H. H. Elsedfy, ‘Bone Mineral Density and Calcium Metabolism in Adoles-cents with Beta-Thalassemia Major’, Pediatric Endocrinol-ogy Reviews, 6 Suppl 1 (2008), 132-5.

Ploutarchos Tzoulis, Ai Leen Ang, Farrukh T. Shah, Marko Berovic, Emma Prescott, Romilla Jones, and Maria Bar-nard, ‘Prevalence of Low Bone Mass and Vitamin D Defi-ciency in Β-Thalassemia Major’, Hemoglobin, 38 (2014), 173-78.

B. Wonke, ‘Bone Disease in Beta-Thalassaemia Major’, Br J Haematol, 103 (1998), 897-901.

B. Wonke, C. Jensen, J. J. Hanslip, E. Prescott, M. Lalloz, M. Layton, S. Erten, S. Tuck, J. E. Agnew, K. Raja, K. Da-vies, and A. V. Hoffbrand, ‘Genetic and Acquired Predis-posing Factors and Treatment of Osteoporosis in Thalas-saemia Major’, J Pediatr Endocrinol Metab, 11 Suppl 3 (1998), 795-801.


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