The differences of 25-hydroxyvitamin d and malondialdehyde levels among thalassemia major and non-thalassemia

Abstract

Background: Patients with thalassemia major who require regular blood transfusions, have experienced a decline in the level of 25-Hydroxyvitamin D and an increase in oxidative stress biomarkers, one of which is Malondialdehyde (MDA). Both mechanisms are thought to be associated with iron overload seen in transfusion-dependent thalassemia patients. It is necessary to research the differences in 25-hydroxyvitamin D and malondialdehyde levels among thalassemia major and non-thalassemia patients along with the increasing prevalence of thalassemia. The study aims to prove the differences in 25-hydroxyvitamin D and malondialdehyde levels among thalassemia major and non-thalassemia patients. Methods: The study was an observational analytic study with cross sectional approach. Research subjects were 42 children consisting of 21 thalassemia major patients hospitalized at the Dr. R. Soedjati Grobogan Public Hospital and Dr. R. Soetrasno Rembang Public Hospital and 21 healthy children were matched for age. This study was conducted from March to September 2020. 25-Hydroxyvitamin D and malondialdehyde levels were examined using the enzyme-linked immunosorbent assay (ELISA) method and Thiobarbituric acid reactive substances (TBARS) method. Statistical analysis was done using Independent Sample T test and Mann-Whitney test, which p<0.05 was considered significant. Results: There was no significant difference in the level of 25-hydroxyvitamin D (p = 0.45) in thalassemia major and non-thalassemia patients (25.96 ± 6.36 ng/mL and 27.54 ± 7.09 ng/mL respectively). There was a significant difference in the malondialdehyde level (p = 0.00) in thalassemia major and non-thalassemia patients (0.43 µmol/L and 0.14 µmol/L respectively). Conclusion: Iron overload in patients with thalassemia major causes a decrease in 25-hydroxyvitamin D level. An insignificant difference in 25-hydroxyvitamin D level among thalassemia major and non-thalasemia indicates that other factors such as nutritional status, nutrient intake, and sun exposure also play an important role in 25-hydroxyvitamin D level. The formation of ROS triggered by iron overload also results in a significant increase of malondialdehyde level in thalassemia major.