Abstract

Objective: Iron is an element, which is found in the structure of antioxidant enzymes and has an important role in the inactivation of reactive oxygen species. Disruption of oxidant-antioxidant balance may be playing a role in the pathogenesis of iron deficiency anemia (IDA). Dynamic thiol-disulfide homeostasis (DTDH) and serum ischemia-modified albumin (IMA) levels are important indicators of pro-oxidant/antioxidant status. In this study, we aimed to evaluate DTDH parameters and serum IMA levels in children with newly diagnosed IDA, who did not receive iron therapy.

Material and Methods: Fifty patients diagnosed with IDA and 33 healthy age- and sex-matched control patients were included in the study. DTDH parameters and IMA levels of the patients and control groups were measured. The same parameters were also compared in patients with Hb<7 g/dl (profound IDA) (n:14/50, 28%) and Hb≥7 g/dl (mild-moderate IDA) (n: 36/50, 72%) in the IDA group. The relationship between DTDH parameters in these groups were investigated.

Results: Native thiol, total thiol, native thiol/total thiol levels, constituting antioxidant capacity indicators, were found to be significantly lower in IDA patients; while oxidant disulfide, disulfide/native thiol, disulfide/total thiol, and IMA levels were found to be statistically higher compared to those in the control group (p<0.050). When DTDH parameters and IMA levels were examined; there was a positive correlation between antioxidant parameters and a negative correlation between oxidative parameters with hemoglobin and ferritin levels (p<0.050). Also, oxidative parameters were found to be much higher in profound IDA group than in the group with Hb>7 g/dl (p<0.050).

Conclusion: In this study, increase in serum disulfide and IMA levels with the decrease in serum native thiol and total thiol levels indicated oxidative stress in IDA patients before treatment, compared to the control group. Evaluation of these indicators in children is important in predicting the toxicity due to IDA.

Keywords: Hemoglobin, Iron deficiency anemia, Ischemia modified albumin, Oxidative damage, Thiol-disulfide

References

  1. Armitage AE, Moretti D. The importance of iron status for young children in low- and middle-income countries: a narrative review. Pharmaceuticals (Basel) 2019;12:59.
  2. Gao J, Zhou Q, Wu D, Chen L. Mitochondrial iron metabolism and its role in diseases. Clin Chim Acta 2021;513:6-12.
  3. Sharma R, Nachane H. Oxidative stress in iron deficiency anemia-a gender-based analysis-a pilot study. J Evolution Med Dent Sci 2020;9:3739-42.
  4. Kontoghiorghes GJ, Kontoghiorghe CN. Iron and chelation in biochemistry and medicine: new approaches to controlling iron metabolism and treating related diseases. Cells 2020;9: 1456.
  5. Hamed HM, Motawie AA, Abd Al-Aziz AM, El-Saeed GSM, El Wasseif M, Mourad AA, et al. Low Dose Iron Therapy in Children with Iron Deficiency: DNA Damage and Oxidant Stress Markers. Indian J Hematol Blood Transfus 2021;37:287-94.
  6. Sharif Usman S, Dahiru M, Abdullahi B, Abdullahi SB, Maigari UM, Ibrahim Uba A. Status of malondialdehyde, catalase and superoxide dismutase levels/activities in schoolchildren with iron deficiency and iron-deficiency anemia of Kashere and its environs in Gombe State, Nigeria. Heliyon 2019;5:e02214.
  7. Mehram EB, Ahmed SA, Elhassaneen YA. Role of Oxidant/Antioxidant Status in the Pathogenesis of Iron-Deficiency Anemia: Case Study on Children of Qalyubiyya and Minoufiya Governorates, Egypt. Bulletin of the National Nutrition Institute of the Arab Republic of Egypt 2020;55:39-71.
  8. Guven S, Meral I, Kurdoglu M, Demir H. The Nutritional Habits and Relationship Between The Antioxidant Activity and Iron Deficiency Anemia During Pregnancy. East J Med 2022;27:317-24.
  9. Ulrich K, Jakob U. The role of thiols in antioxidant systems. Free Radic Biol Med 2019;140:14-27.
  10. Erel O, Neselioglu S. A novel and automated assay for thiol/disulphide homeostasis. Clin Biochem 2014;47:326-32.
  11. Özcan O, Erdal H, İlhan G, Demir D, Gürpınar AB, Neşelioğlu S, et al. Plasma Ischemia-Modified Albumin Levels and Dynamic Thiol/Disulfide Balance in Sickle Cell Disease: A Case-Control Study. Turk J Haematol 2018;35:265-70.
  12. Bar-Or D, Lau E, Winkler JV. A Novel assay for cobaltalbumin binding and its potential as a marker for myocardial ischemia-a preliminary report. J Emerg Med 2000;19:311-15.
  13. East P, Doom JR, Blanco E, Burrows R, Lozoff B, Gahagan S. Iron deficiency in infancy and neurocognitive and educational outcomes in young adulthood. Dev Psychol 2021;57: 962-75.
  14. Zaky EA, Mahmoud ZK, Abd El Wahab MM, Kamel SK. The effect of Iron Deficiency Anemia on Intelligence Quotient in children. MJMR 2021;32:66-8.
  15. Sundararajan S, Rabe H. Prevention of iron deficiency anemia in infants and toddlers. Pediatr Res 2021;89:63-73.
  16. Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Ann N Y Acad Sci 2019;1450:15-31.
  17. 1Jakubczyk K, Dec K, Kałduńska J, Kawczuga D, Kochman J, Janda K. Reactive oxygen species-sources, functions, oxidative damage. Pol Merkur Lekarski 2020:22;48:124-7.
  18. Dilber B, Akbulut UE, Serin HM, Alver A, Menteşe A, Kolaylı CC, et al. Plasma and Erytrocyte Oxidative Stress Markers in Children with Frequent Breath-Holding Spells. Klin Padiatr 2021;233:173-80.
  19. Aslaner H, Dündar MA, Arslan A, Karakükcü Ç, Altuner Torun Y. Reduced antioxidant capacity in children with iron deficiency and iron-deficiency anemia. Minerva Pediatr (Torino) 2021. Epub ahead of print.
  20. Aycicek A, Koc A, Oymak Y, Selek S, Kaya C, Guzel B. Ferrous sulfate (Fe2+) had a faster effect than did ferric polymaltose (Fe3+) on increased oxidant status in children with iron-deficiency anemia. J Pediatr Hematol Oncol 2014;36:57-61.
  21. Akca H, Polat A, Koca C. Determination of total oxidative stress and total antioxidant capacity before and after the treatment of iron-deficiency anemia. J Clin Lab Anal 2013; 27:227-30.
  22. Akarsu S, Demir H, Selek S, Oguzoncul F. Iron deficiency anemia and levels of oxidative stress induced by treatment modality. Pediatr Int 2013;55:289-95.
  23. Topal I, Mertoglu C, Sürücü Kara I, Gok G, Erel O. Thiol-Disulfide Homeostasis, Serum Ferroxidase Activity, and Serum Ischemia Modified Albumin Levels in Childhood Iron Deficiency Anemia. Fetal Pediatr Pathol 2019;38:484-9.
  24. Shevtsova A, Gordiienko I, Tkachenko V, Ushakova G. Ischemia-Modified Albumin: Origins and Clinical Implications. Dis Markers 2021;2021:9945424.
  25. Bilgili S, Bozkaya G, Tütüncüler FK, Akşit M, Yavuz M. Investigation of ischemia modified albumin levels in iron deficiency anemia. Turk J Biochem 2017;42:259-64.
  26. Fahim FM, Helal SR, Fathalla E, Saeed AN, Galal SM. Platelets abnormalities in children with iron deficiency anemia. J Curr Med Res Pract 2022;7:22-8.
  27. Han DD, Ma C, Zhao L, Gao YJ, Su YH. Relationship between Iron Metabolism and Platelet Parameters in Patients with Iron Deficiency Anemia. Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2018;26:1738-41.
  28. Chalise S, Acharya N, Pradhan SB. Correlation between Iron Parameters and Platelet Parameters in Iron Deficiency Anemia. JIOM Nepal 2019;41:35-8.
  29. Durmus A, Mentese A, Yılmaz M, Sumer A, Akalın I, Topal C. Increased oxidative stress in patients with essential thrombocythemia. Eur Rev Med Pharmacol Sci 2013;17:2860-66.

Copyright and license

Copyright © 2023 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Kurucu B, Fettah A, Yeşil Ş, Fırat Oğuz E, Erel Ö, Şahin G. Dynamic Thiol-Disulfide Homeostasis in Children with Newly Diagnosed Iron Deficiency Anemia. Turk J Pediatr Dis [Internet]. 2023 Jan. 30 [cited 2025 Aug. 23];17(1):56-61. Available from: https://turkjpediatrdis.org/article/view/1006