A clinical study of hemoglobin E with special reference to serum ferritin level

Abstract

Introduction: The spectrum of anaemia is modified in many parts of world, due to prevalence haemoglobinopathies. The common haemoglobinopathies includes HbS, HbC, D (Punjab) and E. In Assam with its population consisting of diverse ethnic groups, is a rich reservoir of abnormal haemoglobin and thalassaemia. The incidence of HbE from various population survey of Assam showed that 20% among Indig Assamese, 57.4% among Ahoms and as high as 80% among Bodo-Kacharis. Iron therapy is hazardous in haemoglobinopathies due to risk of tissue iron toxicity, so needs evaluations of iron status before iron therapy. The size of the stored iron in the body is accurately indicated by serum ferritin estimation, which is single most sensitive and non-invasive method for iron status evaluation. Keeping all in minds the aim of the our study is to study the serum ferritin level of patients with HbE attending AMCH, Dibrugarh. Materials and Methods: This study was conducted in the department of medicine, AMCH for 1-year. 80 HbE patients of various religions and tribes were selected for study. Patients with HbE having malignancy, end stage renal disease, arthritis, chronic liver disease, and sepsis were excluded from the present study by careful history taking and laboratory investigations. Serum ferritin level was estimated by IRMA technique. Result and Observation : The incidence of HbE disease (E/E), trait (A/E) and HbE-thalassaemia (E/F) was 47.5%, 42.5%& 10% respectively. Most of the patients were in their second and third decade (57.5%). Male female ratio was 13:7, most being Ahom (60%) and Kochari (12.5%). The haemoglobin concentration in A/E, E/E and E/F were 8.94±0.928, 8.04±0.8840 and 6.02±0.1500; serum ferritin level 24.95±11.90, 162.26±59.5 and 1017±322.19 respectively. E/E patients on blood transfusions have a higher level of serum ferritin (122.85±4.95) than those without transfusions (95.75±9.54). Again those cases of E/F on regular blood transfusions have a higher ferritin (1260±188.14) level than those with occasional transfusions (715±155.80). Conclusion : Serum ferritin assay IRMA technique is simple and suitable for evaluation of serum iron status. Iron deficiency may be seen among HbE trait but normal or higher serum ferritin in E/E and E/F cases in this study suggests that indiscriminate iron therapy could be harmful in most of the patients without prior evaluation of serum ferritin.

Keywords

• Serum ferritin
• HbE
• HbE trait
• HbE disease
• HbE thalassaemia