International Journal of General Medicine (Oct 2021)
Oxidative Stress (Malondialdehyde) in Adults Beta-Thalassemia Major and Intermedia: Comparison Between Before and After Blood Transfusion and Its Correlation with Iron Overload
Abstract
Tubagus Djumhana Atmakusuma,1 Intan Russiana Nasution,2 Noorwati Sutandyo3 1Division of Hematology-Medical Oncology, Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital/Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; 2Division of Hematology-Medical Oncology, Department of Internal Medicine, Gatot Soebroto Army Hospital Jakarta/Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; 3Division of Hematology-Medical Oncology, Department of Internal Medicine, Dharmais National Cancer Hospital Jakarta/Faculty of Medicine Universitas Indonesia, Jakarta, IndonesiaCorrespondence: Tubagus Djumhana AtmakusumaDivision of Hematology-Medical Oncology, Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital/Faculty of Medicine Universitas Indonesia, Jalan Diponegoro No. 71, Jakarta Pusat, DKI, Jakarta, IndonesiaEmail [email protected]: Iron overload is a major problem in both transfusion-dependent (TDT) and non-transfusion-dependent thalassemia (NTDT). It has been known to increase oxidative stress. Meanwhile, blood transfusion as main therapy for thalassemia increases iron overload. One of the markers of oxidative stress is malondialdehyde (MDA). This study aims to provide data on MDA levels in adult thalassemia patients, and to compare the levels before and after transfusion in patients with TDT and NTDT.Methods: This is a cross-sectional, pre-post study in adult patients with thalassemia major and intermedia that received blood transfusion with or without iron-chelating agents in Cipto Mangunkusumo Hospital. Blood samples were taken immediately before the transfusion and one day after. Serum ferritin (SF) assays were conducted by electrochemiluminescence immunoassay method, while transferrin saturation (TS) was calculated by dividing serum iron by the binding capacity. Subsequently, plasma MDA levels assays were performed using the Wills method, and data analysis was conducted using the t-test/Mann–Whitney and Pearson/Spearman correlation test, depending on the data distribution.Results: The 63 respondents recruited consist of 51 TDT and 12 NTDT patients, and their median plasma MDA level before and after transfusion was 0.49 μmol/L and 0.45 μmol/L, respectively. Before transfusion, there was no correlation between SF and MDA, and TS and MDA levels. After the transfusion, there was no correlation between, SF and MDA, or TS and MDA levels.Conclusion: There is no significant difference in MDA levels before and after transfusion. Although blood transfusion increases the iron load in thalassemia patients, there was no increase in median MDA level after transfusion. Meanwhile, there was no correlation between markers of iron overload and MDA level in thalassemia patients both before and after transfusion.Keywords: iron overload, malondialdehyde, oxidative stress, non-transfusion dependent thalassemia, transfusion-dependent thalassemia
