Status of Zinc, Iron and some Biochemical Parameters in patients with Polycythemia

 

Wafaa Sh. Al - Zuhairi, Ekhlas Abdallah Hassan, Alzahraa Ibrahim Abdulmajeed

Department of Chemistry, College of Science, University of Diyala, Baquba, Diyala, Iraq.

*Corresponding Author E-mail: wafaa.chem@gmail.com, ekhlasbiochemistry@gmail.com, Zahraa1987.zo@gmail.com

 

ABSTRACT:

The goal of this study is to determine the concentration of total zinc, iron, ESR, PCV, Hb, CBC in the serum of patients with polycythemia vera. These results are indicated that age of patient and control group Iraq males are to some extend similar. Whereas, average value of ESR ±SD for patient and control groups were (8.36± 4.41) and (15.40± 5.10), respectively. It was clearly indicated that ESR for patient higher than control group. The erythrocyte sedimentation rate (ESR) is decreased due to an increase in zeta potential. While, the average iron ±SD for patient and control group were (35.12 ± 8.21) and (23.48 ± 2.40) respectively. The level of zinc shows no significant difference between polycythemic and control gropes. Also show that there was a highly significance in packed cell volume between patient groups (51.49±4.62) when compared with control groups (36.30±3.22). The mean ±SD of Hb and WBC for patient and control group were (16.08 ± 1.14) (12.40 ± 0.68) and (12.04 ± 3.17) (8.21 ± 1.48) respectively. These results are showed that Hb, WBC of patient strongly higher compering to control group (p>0.05). the majority of patients were at the age between (41-50) years with percentage of (30.76%), (31-40) years with a percentage (25.64%) and (20-30) years with a percentage (23.07%).  While age groups between (51-60) years were (12.82%) and age groups (>60) years were (7.7%). The result show that (2.5) percent of patients had PCV level less than normal, (38.5) percent of patients had normal level and (59) percent of patients showed concentration more than normal as shown in (Table 4). There are (5.1) percent of patients showed level less than normal, (53.8) percent of patients had normal level and (41) percent of patients showed concentration more than normal. The current study has been shown that the concentration of biochemical parameters is influenced by polycythemia.

 

KEYWORDS: Polycythemia, Zinc, Iron, Patients.

 

 


INTRODUCTION:

Polycythemia is also known as polyglobulia, is revealed that increased the cell of red blood count as well the level of hemoglobin above the nominal range which mean a rise of total red cells volume arising from an abnormal gene1. Polycythemia can be recognized Clinically when the hematocrit (PCV) level is more than 47% in females and 55% in males2. In polycythemia, there are three types: primary polycythemia, secondary polycythemia, and stress polycythemia which are based on lifestyle and age.

 

Primary polycythemia is also known as polycythemia vera is rarely seen or the true polycythemia. which is produced by clonal that leads to undue in white blood cells production, red blood cells, platelets also their progenitors3,4,5. In the world 22 per 100,000 an incidence in Primary polycythemia which means it is an uncommon disease6. The rise in red blood cell production in bone marrow leads to Secondary polycythemia disease. The reduction in the concentration of oxygen in the blood, which is caused by different reasons like heavy smoking, in high altitude residents where oxygen levels are naturally low, a pulmonary disease resulting in cardiovascular disease, and hypoventilation associated with obesity. Besides, exposure to chemicals such as sulphonamides, nitrites, another material producing sulphaemoglobin, methemoglobin, and different alcohols. all these can cause Secondary polycythemia disease2,7. Stress polycythemia is a type in which the volume of blood plasma is decreased, however, production of the red cells is normal. That can be a result of plasma loss like enteropathy, burns, and dehydration2. All the different polycythemia types have the same indications which may include: plethora and headache blurred vision2,8. Other symptoms may be itching particularly after exposure to warm water like taking a shower or particularly itching9. That might be affected by prostaglandin production or unusual histamine       release 10,11 . The patients with polycythemia vera also may have A peptic ulcer, this assumed to be due to increased histamine released from mast cells which may be associated with the capability of the ulcer-causing bacterium H. pylori infection12. although, polycythemia is not a new disease still its reasons obscure after ten years of laboratory investigations and careful clinical as well there is no consensus regarding its therapy2. Zinc is very important for the function and structure of membranes and the conservation immune system. it is a co-factor for more than 300 enzymes13. Hence the goal of this research was to discover the influence of the disease on level Biochemical Parameters in Serum Among Iraq Patients.

 

MATERIALS AND METHODS:

In this study, the cases were (females and males) aged 26-65 years. The cases were classified in two groups, first groups have polyslathmai (n=39) whose haematocrit (PCV) were ≥ 55% and the second one as controls (n=10). The subject of the study was covered by an External laboratory and they have been estimated for Zinc, Iron, ESR, and PCV levels. The research was carried out from March 2019 to November 2019. History disease of patients, therapy as well as demographic data and anthropometric has been listed by the measure of laboratory and medical records.  the patient’s weight without shoes and minimum clothes measured by used a scale; the precision of the instrument rate is 100gr. From each subject, 5ml of blood by syinge from vein after seeking their consents and approval 2ml was dispensed into ethylene-diaminetetraacetic acid (EDTA) anticoagulated bottle for haematocrit (PCV) and (ESR) estimation using micro haematocrit centrifuge while the remaining (3ml) was dispensed into sterile plain bottle with each blood specimen allowed to clot, carefully retracted and spun, thereafter the serum was collected and the Iron and another parameter were measured quantitatively with spectrophotometer using.

 

RESULT AND DISSOCIATION:

Table (1) show that the average age±SD for patient and control group were (40.87±11.63) and (41.80±11.4) years respectively. These results are indicated that age of patient and control group Iraq males are to some extend similar. Whereas, average value of ESR ±SD for patient and control groups were (8.36±4.41) and (15.40±5.10), respectively. It was clearly indicated that ESR for patient higher than control group. Increase in zeta potential cause decreased the erythrocyte sedimentation rate (ESR). polycythemia patients have a low erythropoietin (EPO) level because polycythemia vera results fundamental reduction in erythrocyte production. While, the average iron ±SD for patient and control group were (35.12±8.21) and (23.48±2.40) respectively. Okpokam et al 2012, found a strong and significant correlation between PCV and iron among adult male14.  In addition, the study carries out the zinc concentration shows no significant difference between polycythemic and control gropes as can see in Table 1. Whereas, there was study done by Ahsan K. Abbas et al 2010, that showed the level of zinc in polycythemic patients were significantly higher than that of control subjects [15]. The data from Table (1) also show that there was a highly significance in packed cell volume between patient groups (51.49±4.62) when compared with control groups (36.30±3.22) .The above result showed the packed cell volume increase in polycythemia patients which agreed with other studies which denoted that the packed cell volume increase in polycythemia vera because of uncontrolled red blood cell production which is due to abnormal clone of the hematopoietic stem cell with increased sensitivity to the different growth factor for maturation1,16.

 

The mean ±SD of Hb and WBC for patient and control group were (16.08±1.14) (12.40±0.68) and (12.04±3.17) (8.21 ± 1.48) respectively. These results are showed that Hb, WBC of patient strongly higher compering to control group (p>0.05). Commonly, recognize PV and the patient’s response to therapy the hematocrit concentration is used. Hematocrit is the red blood cells ratio in a volume of blood, habitually expressed as a percent or a rise in the concentration of hemoglobin in the blood. In addition, the mutation is genetic of the JAK2 gene usually associated with polycythemia vera (PV), which is believed that raising the bone marrow cells' sensitivity to Epo, lead to increased production of a red blood cell. in the same condition, levels of other blood cells type like platelets and white blood cells are oftentimes increased.  

 

Furthermore, the mean±SD of lymphocytesin patient and control group were (25.38±8.09) (21.87±8.41) respectively. The result indicated that the lymphocytes in patient higher but no significant. These findings are not agreement with the results reported by C. Sanchez et           al 17.  The mean±SD of RBC and PLT in patient and control group were (6.02±0.68) (4.86±0.92) and (404.7± 131.5) (259.90±68.47) respectively. The signs, symptoms and complications of PV occur because there are too many red cells, and often, too many platelets in the blood. The patient’s blood become thicker when there are too many red blood cells this led to the blood does not flow efficiently. Also, the formation of clots (thrombi) occure when platelet counts increase. the risk of clotting complications especially in older persons with polycythemia may be happened because underlying vascular disease.  The thrombi may be led to many problems, like deep vein thrombosis, stroke, and heart attack.  even before the PV discover in patients the blood clots occur in about 30 percent of them. 40 to 60 percent of untreated PV patients may develop blood clots, through the first ten years after a diagnosis of PV.

 

The mean±SD of BMI in patient and control group were (25.74±4.24) and (22.73±1.25) respectively. It was clearly indicated that BMI for patient higher than control group. The results reported by Akinjide M. Akinnuga et al provided that. the significant correlation was demonstrated between PCV and BMI, especially in male hypertensive subjects 18.

 

Table (1) the mean (±SE) values for variable with their significance in study group

Variable

Patient (39)

Mean ±SD

Control (10)

Mean ±SD

Comparison by significant

Age (years)

40.87 ± 11.63

41.80± 11.4

0.8

ESR (mm/1h)

8.36± 4.41

15.40± 5.10

0.001

Iron (µmol/l)

35.12 ± 8.214

23.48 ± 2.402

0.001

Zinc (µg/dl)

98.71± 3

90.71± 3.19

0.8

PCV(%)

50.56 ± 3.53

39.30 ± 2.11

0.001

Hb (gm/dl)

16.08 ± 1.14

12.40 ± 0.68

0.01

WBC(109  /L)

12.04 ± 3.17

8.21 ± 1.48

0.01

Lymphocytes (109  /L)

25.38 ± 8.09

21.87 ± 8.41

0.2

Eosinophils(%)

2.09 ± 1.93

1.400 ± 1.41

0.2

Neutrophils(%)

6.91± 3.29

5.24 ± 1.9

0.1

Monocytes(%)

0.69 ± 0. 33

0.49 ± 0.17

0.08

Basophils(%)

0.047 ± 0.053

0.03 ± 0.02

0.3

RBC(1012  /L)

6.02± 0.68

4.86 ± 0.92

0.001

PLT(109  /L)

404.7 ± 131.5

259.90± 68.47

0.02

BMI(Kg/m2)

25.74 ± 4.24

22.73 ± 1.25

0.03

 

Table (2) revealed that the distribution of disease among age groups. According to this table, the majority of patients were at the age between (41-50) years with percentage of (30.76%), (31-40) years with a percentage (25.64%) and (20-30) years with a percentage (23.07%).  While age groups between (51-60) years were (12.82%) and age groups (>60) years were (7.7%). The above results agreed with the observation of other studies [19] [20] which observed that most polycythemia patient’s age groups range (40-60) years.

 

 

While the current study disagreed with other             studies16,21,22. Even though the polycythemia vera happening increases with age, but it occurs in all age groups23.

 

These variations may be attributed to the different factors include: Difference in sample size, genetic factor, geographical and environmental differences between Iraq and other countries.

 

Table (2) Distribution of patients according to the age groups

Patients Group

patients No.

Percentage

20-30

9

23.07

31-40

10

25.64

41-50

12

30.76

51-60

5

12.82

>61

3

7.7

Total

39

100

 

Table (3) show that Comparison Iron between patients according to age periods according to this table, the majority of patients were at the age between (41-50) years have a higher level of iron.

 

Table (3) Comparison Iron between patients according to age periods.

 

N

Mean of Iron

F

DF

Sig.

Age

20-30

9

30.22

0.98

21

0.5

31-40

10

32.88

41-50

12

38.57

51-60

5

41.56

>61

3

32.66

Total

39

35.81

 

Table (4) PCV and RBC Level in Polycythemia patients according to Iron Level

Variable

Value

Number%

Iron (mean)

F

DF

Sig.

PCV value

Less than Normal (<40.7 )

1 (2.5)%

9

13

7.5

0.001

>40.7 Normal

15 (38.5)

31.57

>50.3 up Normal

23 (59)

52.56

Total

39 (100)%

31.04

RBC value

Less than Normal (<4.7 )

2 (5.1)

19.9

29

1.1

0.4

>4.7 Normal

21 (53.8)

33.19

≥6.1 up Normal

16 (41)

39.54

Total

39 (100)%

30.87

 

The result show that (2.5) percent of patients had PCV level less than normal, (38.5) percent of patients had normal level and (59) percent of patients showed concentration more than normal as shown in (Table 4). There are (5.1) percent of patients showed level less than normal, (53.8) percent of patients had normal level and (41) percent of patients showed concentration more than normal as can be seen in (Table 4). The PCV rises when the number of red blood cells increases or when the total blood volume is reduced, as in dehydration. The higher level of iron observed in patient have concentration more than normal of PCV and RBC.

 

Multiple linear regression models and a set of explanatory variables on serum iron level were used in order to show the net and independent effect. The first step was to enter all possible explanatory variables in the model. Table (5) shows the resulting equation. Observing a positive correlation between the outcome variable (mean serum Iron level) and (PCV and BMI) was found. The resulting equation was statistically significant (P<0.05) and explains 81% of the observed variation in the dependent variable.

 

A study shows a high mean concentration of serum iron noticed with increased PCV of polycythemia vera patients. This study inducts that apart from PCV being polycythemia vera is attached with a higher mean value of iron. A multiple linear regression model was utilized to prove the results of this study. That showed a positive correlation between PCV, and serum iron.

 

Table(5) Multiple linear regression equation with serum Iron (µmol\l) as the dependent variable and the studied independent variables in patients

Independent Variable

β

Standardized  β

P value

Age

0.008

0.011

0.915

ESR

-0.333

-0.179

0.175

PCV

2.678

1.152

0.049

Hb

-2.086

-0.291

0.578

WBC

-0.136

-0.053

0.739

Lym

0.031

0.030

0.769

Eos

-0.518

-0.122

0.185

Neu

-0.034

-0.014

0.935

Mon

1.312

0.054

0.581

Bas

-1.450

-0.009

0.938

RBC

-1.956

-0.163

0.244

Plt

0.003

0.049

0.640

BMI

2.678

1.152

0.049

R 2 = 0.817  P <0.05

 

CONCLUSION:

The current study has shown that the serum concentration of iron, ESR, Hb, WBC, lymphocytesin, PLT, BMI are affected by polycythemia. Therefore, it is recommended that this parameter with other biochemical parameters should be quantitatively studied in all polycythemic patients and be inverted to normal concentration onto the findings of raised values orderly to stop any subsequent complications. While, the level of zinc shows no significant difference between polycythemic and control gropes.

 

ETHICAL CLEARANCE:

This research was conducted with the approval of the patients volunteers and without mentioning the names with the complete privacy of patients volunteers.

 

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Received on 13.06.2021           Modified on 24.07.2021

Accepted on 21.08.2021         © RJPT All right reserved

Research J. Pharm. and Tech. 2022; 15(5):2093-2096.

DOI: 10.52711/0974-360X.2022.00346