To assess iron deficiency anaemia in patients with cyanotic heart disease compared to general population

Sumeet Soni, Prachi Chaudhary, Sunil Arya, S. Thora

Abstract


Objective: Congenital heart disease has an overall incidence of 8 per 1000 live births. It can be grouped into acyanotic congenital heart diseases (without a shunt or with a left to right shunt) and cyanotic congenital heart disease (with a right to left shunt). Cyanotic congenital heart diseases are those inborn lesions of the heart and great vessels in which there is shunting of blood from right side of the heart to the left side with the result that de-oxygenated blood enters the systemic circulation, thereby decreasing its oxygen saturation and causing cyanosis. The commonest of these diseases is Tetralogy of Fallot's. Only a few of these diseases are compatible with life beyond 12 years of age. Methods: The present study was carried out in the department of Pediatrics, Mahatma Gandhi Memorial Medical College, Indore from January 2012 to July 2013 (duration of study was one and half years). During this period thirty children with congenital cyanotic heart disease between 6 months to 5 years of age were included in this study. Blood parameters assessed were Hemoglobin (Hb gm%), Mean Corpuscular Volume (MCV) fl and Ferritin levels. Results: The mean hemoglobin in cyanotic heart disease cases was 13.39 gm/dl with a S.D. of 2.38. In the control group the mean hemoglobin was 9.57 gm/dl with a S.D. of 1.29. Mean MCV in cyanotic heart disease cases was 71.47 fl with S.D. of 9.28 and in controls it was 78.41 fl with a S.D. of 5.87. Mean Ferritin in cases was 41.63 ng/ml with S.D. of 35.04 and in controls it was 78.75 ng/ml with S.D. of 51.40. P value was 0.001 indicating a statistically significant decreased ferritin in cases. Conclusion: Iron deficiency anemia was present in 56.6% of the cases on basis of MCV. The high iron requirements of cyanotic heart disease cases due to increased erythrocytosis induces iron deficiency anemia.There was statistically significant difference in Hb and MCV values between cases and controls. The ferritin level was statistically significantly lower between cases and controls suggesting iron deficient state in CCHD patients. Iron therapy in iron deficient CCHD (based on hematological and iron indices) patients might improve clinical outcome in these patients.

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References


Nelson WE. Congenital heart disease. In: Nelson WE, Behrman RE, Vaughan VC, eds. Nelson Textbook of Pediatrics 13th ed. Philadelphia: W.B. Saunders Co., 2011, Ch.l4;962.

Keith JD, Rowe RD, Vlad P. Heart Disease in Infancy and Childhood. 3rd ed. New York : Macmillan, 19978, Ch.l.

Perloff JK, Rosove MH, Child JS, Wright GB: Adults with cyanotic congenital heart disease: Hematologic management. Ann Intern med 2008; 109: 406-13.

Ross EA, Perloff JK, Danovitch GM, Child JS, Canobbio MM. Renal function and urate metabolism in late survivors with cyanotic congenital heart disease. Circulation. 1986 Mar; 73 (3):396-400.

Phornphutkul C, Rosenthal A, Nadas AS, Berenberg W. Cerebrovascular accidents in infants and children with cyanotic congenital heart disease. Am J Cardiol 1973; 32:329-34.

Scott WS, Elliot SR, Clay RC. Blood volume in cya­notic congenital heart disease; Simultaneous measure­ments with Evans blue and radioactive phosphorus. Bull Johns's Hopkins Hosp 1951; 121-32.

Hutton RD. Br J Haematol. The effect of iron deficiency on whole blood viscosity in polycythaemic patients. 1979 Oct; 43 (2):191-9.

Card RT, Weintraub LR. Metabolic abnormalities of erythrocytes in severe iron deficiency.Blood. 1971 Jun; 37 (6):725-32.

Koeffler HP, Goldwasser E: Erythropoietin radio-immunoassay in evaluating patients with polycythemia. Ann Intern Med 1981; 94:44-7.

Erslev AJ, Caro J. Pure erythrocytosis classified according to erythropoietin titers. Am J Med. 1984 Jan; 76 (1):57-61.

Jha A: A study of assessment of iron deficiency anemia in children with CCHD.1997

Cemile Banu Onur, Tansul Sipahi, Betul Tavir, Selmin Karademir, Aysel Yoney. Diagnosing Iron deficiency in cyanotic heart disease. Indian J Pediatric 2003; 70 (1):29 -31

H Amoozgar, M Soltani, A Besharati, S Cheriki. Undiagnosed anemia in pediatric patient with congenital heart disease. Iran Cardiovasc Res J 2011; 5 (2): 69-70.

OO Ogunkule: Parameters of iron Deficiency in CCHD. Nigeria. 2012. Journal 34 (2 );12-15

L Olcay, S. Ozer, A Gurgey, M Saralcar, S Ozme, A Bilgic, S Ozkutlu, A Celikar. Parameters of iron deficiency anemia in children with cyanotic heart disease New York Inc.1996

Lang'o MO, Githanga JN, Yuko-Jowi CA. Pre-valence of iron deficiency in children with cyanotic heart disease seen at Kenyatta National Hospital and Mater Hospital Nairobi. East Afr Med J. 2009 Dec; 86 (12 Suppl): S47-51.


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