Serum ferritin, serum nitric oxide, and cognitive function in pediatric thalassemia major
Abstract: Hemolysis and
repeated blood transfusions in children with thalassemia major cause iron
overload in various organs, including the brain, and may lead to
neurodegeneration. Hemolysis also causes decreased levels of nitric oxide,
which serves as a volume transmitter and slow dynamic modulation, leading to
cognitive impairment.
Objective To assess for correlations between serum ferritin as well as
nitric oxide levels and cognitive function in children with thalassemia major.
Methods This analytical study with cross-sectional design on 40
hemosiderotic thalassemia major patients aged 6−14 years, was done at the
Thalassemia Clinic in Dr. Hasan Sadikin Hospital, Bandung, West Java, from May
to June 2015. Serum ferritin measurements were performed by an
electrochemiluminescence immunoassay; serum nitric oxide was assayed by a
colorimetric procedure based on Griess reaction; and cognitive function was
assessed by the Wechsler Intelligence Scale for Children test. Statistical
analysis was done using Spearman’s Rank correlation, with a significance value
of 0.05.
Results Abnormal values in verbal, performance, and full scale IQ were
found in 35%, 57.5% and 57.5%, respectively. Serum nitric oxide level was
significantly correlated with performance IQ (P=0.022), but not with verbal IQ
(P=0.359) or full scale IQ (P=0.164). There were also no significant
correlations between serum ferritin level and full scale, verbal, or
performance IQ (P=0.377, 0.460, and 0.822, respectively).
Conclusion Lower serum nitric oxide level is significantly correlated to
lower cognitive function, specifically in the performance IQ category. However,
serum ferritin level has no clear correlation with cognitive function.
Keywords: thalassemia major;
ferritin; nitric oxide; cognitive functions; WISC-R; pediatric
Author: Septiana Nur Qurbani,
Lelani Reniarti, Alex Chairulfatah
Journal Code: jpkedokterangg170062
