Oxidative Stress (Malondialdehyde) in Adults Beta-Thalassemia Major and Intermedia: Comparison Between Before and After Blood Transfusion and Its Correlation with Iron Overload

Figures & data

Table 1 Characteristics of the Subjects Study According TDT and NTDT Groups Before Transfusion

Characteristics	Adult Beta Thalassemia		Total (TDT+NTDT) (n=63)
	TDT (n = 51)	NTDT (n = 12)
Gender, n (%)
Man	21 (41.2)	5 (41.7)	26 (41.3)
Woman	30 (58.8)	7 (58.3)	37 (58.7)
Age (years), median (min-max)	25 (18–67)	25 (19–66)	25 (18–67)
Diagnosis genotype, n (%)
Beta thalassemia	15 (29.4)	6 (50.0)	21 (33.3)
Beta thalassemia/HBE	36 (70.6)	6 (50.0)	42 (66.7)
BMI (kg/m^2), mean (SD)	18.7 (2)	20 (2.9)	18.97 (2.3)
Iron chelation, n (%)
Deferiprone	40 (78.4)	6 (50)	46 (73.0)
Deferasirox	9 (17.6)	2 (16.7)	11 (17.5)
Deferoxamine	1 (2)	-	1 (1.6)
No chelating agent	1 (2)	4 (33.3)	5 (7.9)
Transferrin saturation (%), median (min-max)	81 (30–100)	85.5 (28–94)	82 (2–100)
≥50%, n (%)	37 (72.5)	11 (91.7)	48 (76.2)
<50%, n (%)	14 (27.5)	1 (8.3)	15 (23.8)
The mean serum ferritin in a year (ng/mL), median (min-max)	3,094 (344–14,012)	3,863 (963–5,944)	3,136 (344–14,012)
≥1000 ng/mL, n (%)	47 (92.2)	11 (91.7)	58 (92.1)
<1000 ng/mL, n (%)	4 (7.8)	1 (8.3)	5 (7.9)
≥2500 ng/mL, n (%)	28 (54.9)	8 (66.7)	36 (57.1)
<2500 ng/mL, n (%)	23 (45.1)	4 (33.3)	27 (42.9)
MDA plasma before transfusion (µmol/L), mean (SD)	0.55 (0.23)	0.44 (0.11)	0.49 (0.21–1.33)
MDA plasma after transfusion (µmol/L), median (min-max)	0.47 (0.1–1.2)	0.41 (0.3–1.49)	0.45 (0.14–1.49)
Hb before transfusion (g/dl), median (min-max)	7.6 (4.90–10.70)	8.05 (5.70–9.80)	7.66 (1.34)
Volume of blood transfused during research (mL), median (min-max)	168 (24–468)	156 (60–528)	546 (220–1,233)
Volume of blood transfusions in the past year (mL), median (min-max)	5,965 (1,918–13,096)	2,124 (280–4,847)	4,847 (280–13,096)
Frequency of transfusions in a year, mean (SD)	10 (4)	4 (2)	8.84 (4.29)

Abbreviations: TDT, transfusion-dependent thalassemia; NTDT, non-transfusion-dependent thalassemia; SD, standard deviation; BMI, body mass index; MDA, malondialdehyde; Hb, hemoglobin.

Table 2 Plasma MDA Levels Before and After Transfusion in Adult Patients with Beta-Thalassemia TDT and NTDT

Variables	Adult Beta Thalassemia (N=63)		p*
	TDT	NTDT
MDA plasma before transfusion (µmol/ L), mean (SD)	0.55 (0.23)	0.44 (0.11)	0.100
MDA plasma after transfusion (µmol/ L), median (min-max)	0.49 (0.14–1.20)	0.38 (0.31–1.49)	0.299

Note: *Mann–Whitney.

Table 3 Change (Delta) Plasma MDA Levels in Adult Patients with Beta-Thalassemia TDT and NTDT Between Before and After Transfusion

Variables	Adult Beta-Thalassemia (TDT + NTDT) N = 57	p
Change (delta) plasma MDA (µmol/ L), median (min-max)	−0.007 ([−0.069] - 0.055)	0.820

Table 4 The Correlation Between Serum Ferritin and Transferrin Saturation with Plasma MDA Levels Before and After Transfusion

Variables	Before Transfusion		After Transfusion
	Pearson Correlation	Spearman Correlation	Pearson Correlation	Spearman Correlation
Serum ferritin vs MDA	r=0.256*	r=0.181	r=0.107	r=0.123
	p=0.043	p=0.156	p=0.428	p=0.361
Transferrin saturation vs MDA	r=0.192	r=0.194	r=0.077	r=−0.090
	p=0.138	p=0.133	p=0.578	p=0.513

Note: *Pearson correlation test: p<0.05.

Table 5 The Proportion of Subjects According to Changes of Plasma MDA Levels Before and After Transfusion in Adult Patients with Thalassemia Beta TDT and NTDT

Changes in Plasma MDA	Adult Beta Thalassemia		Total
	TDT, n (%)	NTDT, n (%)
Increase	19 (39.6)	5 (55.6)	24 (42.1)
Permanent	1 (2.1)	0 (0)	1 (1.8)
Decline	28 (58.3)	4 (44.4)	32 (56.1)

Figure 1 Line graph depicting the increase (left), stagnation (middle), and decrease (right) in MDA levels between study subjects, pre and post transfusion.