Changes in coagulation status in patients with β-thalassemia in Iraq: A case-control study

Abstract

Background: The pathogenesis β-thalassemia is characterized by anemia resulting from reduced β-globin synthesis with low hemoglobin A (HbA) production and higher production of hemoglobin A2 (HbA2) and fetal hemoglobin (HbF). However, thromboembolic events have been recently identified in patients with β-thalassemia due to hypercoagulable state. Objectives: The aim of this study was to evaluate the levels of some coagulation markers in Iraqi patients with β-thalassemia major and β-thalassemia intermedia. Materials and Methods: The study included three groups. The first group included patients with β-thalassemia major (n = 39), the second group included patients with β-thalassemia intermedia (n = 11), and third group included 20 apparently healthy control subjects. Each of prothrombin time (PT), activated partial thromboplastin time (APTT), antithrombin III (ATIII), and thrombin-antithrombin III (TAT) complex were measured according to the standard protocols. Results: Both PT and APTT in β-thalassemia major and β-thalassemia intermedia were higher than that of the control group with a highly significant difference (P = 0.002), whereas no significant differences were observed between patients with β-thalassemia major and β-thalassemia intermedia. Mean ATIII level was highest in the control group followed by β-thalassemia intermedia and then by β-thalassemia major groups (P < 0.001), whereas mean TAT complex was highest in thalassemia major group followed by β-thalassemia intermedia and then by control groups (P < 0.001). Conclusions: Prolonged PT and APTT in patients with β-thalassemia together with the reduction in the level of anticoagulant factor (ATII) suggest a role for liver impairment; however, the significantly higher TAT complex is suggestive of ongoing activation of coagulation cascade in patients with β-thalassemia.

Keywords

• β-thalassemia
• coagulation
• iraq