ESTIMATION OF THE LEVELS OF SOLUBLE CD40 LIGAND AND INTERLEUKIN-6 IN RELATION TO CARDIAC DYSFUNCTION IN PATIENTS WITH THALASSEMIA

Abstract

Thalassemia is a genetically determined defect in Hb synthesis. -thalassemia is associated with either reduced synthesis or total absence of -globin chains. It constitutes a major health problem especially in Mediterranean region and in Egypt. Patients are transfusion-dependent and they are exposed to a spectrum of transfusion-induced complications, notably iron overload.

Iron overload is a leading cause of complications of the disease; most of the patients die from cardiac siderosis, pulmonary hypertension and heart failure. The mechanisms of cardiac dysfunction in patients with TMP are multifactorial.

The present work aims at determining the levels of sCD40 ligand (in PPP and serum) and serum IL-6 in relation to hematological data and Echocardiographic pattern in TMP in order to extrapolate their prognostic value in TMP.

The study was conducted on a total of twenty-two TMP (13 males & 9 females) recruited from the Hematology department and Cardiac unit, Medical Research Institute, University of Alexandria. Ten healthy age & sex matched subjects served as controls.

TMP were divided into two groups: eleven splenectomized TMP (gp 1) and eleven non splenectomized TMP (gp 2). All subjects under study were subjected to the following:

1- Complete history taking and thorough clinical examination.

2- Hematological studies including:

a. Complete blood count (CBC).

b. Erythrocyte sedimentation rate (ESR). c. Hemoglobin electrophoresis. d. Serum ferritin.

e. Highly sensitive C-Reactive protein (hs-CRP) by nephelometry.

3- Echocardiographic studies at rest for assessment of: •!• Left and Right ventricular dimensions and functions.

•!• Pulmonary artery pressure.

4- Estimating of sCD40L and IL-6 by ELISA technique.

Statistical analysis of the hematological studies obtained in the present study revealed a significant increase in all parameters of the complete blood count (CBC) (HB, RBCs, WBCs, Platelets count, % Lymphocyte, ALC and MPV) in the TMP groups as compared to their corresponding controls (P< 0.016).

Our results revealed also a statistically significant increase in the serum ferritin and CRP levels in the TMP groups when compared to the controls (P< 0.0001).

The immunological results showed a significant increase in the levels of sCD40L and IL-6 in the TMP groups when compared to the controls (P< 0.0001).