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Article Type

Original Study

Abstract

Background: Transfusion-dependent thalassemia (TDT) is associated with various symptoms including anaemia and bone problems. There is a need for more biomarkers of calcium disorders in TDT patients. In the present study, DKK 1 and HMGB1 are studied in TDT patients with hypocalcemia (TDT+Hypocalcemia) and normocalcemia (TDT+Normocalcemia) as a function of inflammation. Methods: TDT patients were classified according to the cut-off value (2.12 mM) of the adjusted serum calcium (Adj.T.Ca) into TDT+Normocalcemia (n = 54) and TDT+Hypocalcemia (n = 41) groups. Forty healthy controls have participated in the present study. DKK1 and HMGB1 were measured using the ELISA technique. Results: Both patient groups have significantly higher DKK1, HMGB1, C-reactive protein, and ferritin than the control groups. The TDT+Hypocalcemia group has a significantly higher serum DKK1 level than the TDT+Normocalcemia. The results show CRP has a significant correlation with DKK1 and ferritin, in addition to a significant inverse correlation with splenomegaly, and adj.T.Ca. There is also a significant correlation between HMGB1 and DKK1. DKK1 also has a significant inverse correlation with sex, splenomegaly, and Adj.T.Ca. The results of receiver operating characteristics (ROC) revealed an increase in DKK1 more than the cut-off concentration (901.44 pg/ml) indicating that the TDT subjects may have hypocalcemia significantly (p < 0.001) in a sensitivity of 73.2% and specificity of 72.2% (Youdin's J statistic = 0.454). While HMGB1 and ferritin have no significant predictability of hypocalcemia. Conclusion: DKK1 is an important factor in hypocalcemia in TDT patients and may act as a drug target for the treatment of bone disorders in thalassemia patients.

Keywords

Thalassemia, Hypocalcemia, DKK 1, Calcium, HMGB1

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