Blood Res.  2019 Mar;54(1):38-44. 10.5045/br.2019.54.1.38.

Microcytosis in children and adolescents with the sickle cell trait in Basra, Iraq

• Jaber RZ
• Hassan MK
• Al-Salait

• KMID: 2451054
• DOI: http://doi.org/10.5045/br.2019.54.1.38

Abstract

BACKGROUND
Microcytic anemia, the most common form of anemia in children and adolescents, is a heterogeneous group of diseases that is acquired or inherited. We assessed the frequency and causes of microcytosis in children and adolescents with the sickle cell trait (SCT).
METHODS
This descriptive study included 95 subjects (49 males and 46 females) with SCT who attended Basra Center for Hereditary Blood Diseases for evaluation. Investigations included complete blood count, high performance liquid chromatography, capillary electrophoresis, and measurement of serum ferritin and transferrin levels.
RESULTS
SCT subjects had a low hemoglobin (Hb) concentration (9.79±1.75 g/dL), low mean corpuscular volume (MCV, 67.43±9.22), low mean corpuscular Hb (21.15±3.64), and a normal red cell distribution width (RDW, 14.00±2.30). Among 95 SCT subjects, 81 (85.26%) had microcytosis, 12 (12.63%) had normal MCV, and 2 (2.11%) exhibited macrocytosis. Sixty-three (77.78%) SCT subjects with microcytosis were iron deficient, and 18 (22.22%) had normal iron levels. The mean serum ferritin and HbA2 levels were significantly lower, while the RDW, sickle Hb, and serum transferrin levels were significantly higher in patients with microcytosis and iron deficiency compared to non-iron deficient subjects (P<0.05). Correlation coefficients did not reveal a significant association between the MCV and iron status of SCT subjects (P>0.05).
CONCLUSION
Despite the frequent occurrence of iron deficiency in SCT subjects, co-inheritance of alpha-thalassemia seemed to be the cause of low MCV in non-iron deficient individuals with microcytosis. Genetic analysis is required to understand the genetic basis of this phenomenon.

Keyword

Microcytosis; Sickle cell trait; Children

MeSH Terms

Adolescent*
alpha-Thalassemia
Anemia
Blood Cell Count
Child*
Chromatography, Liquid
Electrophoresis, Capillary
Erythrocyte Indices
Ferritins
Hematologic Diseases
Humans
Iraq*
Iron
Male
Sickle Cell Trait*
Transferrin
Ferritins
Iron
Transferrin

Figure

• 

  Fig. 1 Correlation between MCV level and iron status in SCT children and adolescents (Spearman's rho correlation test, −0.063; P=0.546).

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  Fig. 2 Correlation between MCV level and iron status in ID SCT (N=63) (A, Spearman's rho, −0.356; P=0.004), and non-ID SCT (N=18) (B, Spearman's rho, 0.258; P=0.301) children and adolescents with microcytosis.

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