Ağır Demir Eksikliği olan Çocuk Hastalarda Vitamin D Düzeyi

Yıl 2021, Cilt: 43 Sayı: 3, 202 - 210, 07.05.2021

Mustafa Çobanuşağı Can Acıpayam , Hatice Güneş , Fatih Temiz Behiye Nurten Seringeç Akkeçeci , Fatma İnanç Tolun

https://doi.org/10.20515/otd.793743

Öz

Bu çalışmada ağır demir eksikliği anemisi olan çocuklarda Vitamin D eksikliği sıklığının belirlenmesi amaçlanmıştır. Bu çalışmaya 6-72 ay arasında ağır demir eksikliği anemisi olan 60 hasta ile benzer yaş ve cinsiyette 60 sağlıklı çocuk dahil edildi. Hasta grubuna kan hemoglobin düzeyi 7 g/dl'nin altında ağır demir eksikliği anemisi tanısı alan hastalar dahil edildi. Aneminin etiyolojisi ile ilgili olarak hasta grubundan hemogram, retikülosit sayımı, biyokimyasal analizler, serum demir ve demir bağlama kapasitesi, transferrin satürasyonu, ferritin, vitamin B12, folik asit ve serum Vitamin D düzeyleri için kan örneği alındı. Vitamin D eksikliği (<20 ng/mL) hasta grubunun %75'inde (n=45), kontrol grubunun %1.7'sinde (n=1) mevcuttu (p<0.001). Hasta grubunun Vitamin D düzeyi (16.2±13.3 ng/ml), kontrol grubuna (36.3±15.1 ng/ml) göre anlamlı olarak düşüktü (p<0.05). Kontrol grubunda gelişme geriliği olan çocuk bulunmazken, hasta grubunun %16.7'sinde gelişme geriliği vardı (p<0.001). Vitamin D eksikliği çok yüksek prevalansa sahiptir ve ağır demir eksikliği anemisi olan hastalarda Vitamin D düzeyi anlamlı olarak düşük bulunmuştur. Sonuç olarak, ciddi demir eksikliği anemisi olan hastalar Vitamin D eksikliği açısından değerlendirilmeli ve tedavi edilmelidir.

Anahtar Kelimeler

Ağır demir eksikliği anemisi, D vitamini eksikliği, Çocukluk, Gelişimsel gerilik, Transfüzyon

Vitamin D Level in Pediatric Patients with Severe Iron Deficiency Anemia

Öz

This study aimedto determine the frequency of Vitamin D deficiency in children with severe iron deficiency anemia. This study included 60 patients with severe iron deficiency anemia between 6 and 72 months and 60 healthy children with similar age and sex. Patients diagnosed with severe iron deficiency anemia with blood hemoglobin level below 7 g/dl were included in the patient group. Regarding the etiology of anemia, a blood sample was taken from the patient group for hemogram, reticulocyte count, biochemical analyses, serum iron and iron binding capacity, transferrin saturation, ferritin, vitamin B12, folic acid and serum Vit D levels. Vitamin D deficiency (<20 ng/mL) was present in 75% (n=45) of the patient group, while 1.7% (n=1) of the control group (p<0.001). Vitamin D level of the patient group (16.2±13.3 ng/ml) was significantly lower than the control group (36.3±15.1 ng/ml) (p<0.05). While there were no children with retardation in the control group, 16.7% of the patient group had developmental retardation (p<0.001). Vitamin D deficiency has very high prevalence and Vitamin D level was found to be significantly low in patients with severe iron deficiency anemia. Consequently, patients with severe iron deficiency anemia should be evaluated and treated for Vitamin D deficiency.

Anahtar Kelimeler

Severe iron deficiency anemia, Vitamin D deficiency, Childhood, Developmental retardation, Transfusion

Kaynakça

• 1. Christian P and Tielsch JM. Evidence for multiple micronutrient effects based on randomized controlled trials and meta-analyses in developing countries. J Nutr 2012 (1); 142: 173S–7.
• 2. Suskind DL. Nutritional deficiencies during normal growth. Pediatr Clin North Am 2009; 56 (5): 1035–1053.
• 3. Powers JM, Mahoney DH and Drutz JE. Iron deficiency in infants and children <12 years: Screening, prevention, clinical manifestations and diagnosis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com (Last accessed: April 2020).
• 4. Balcı YI, Karabulut A, Gürses D, et al. Prevalance and risk factors of anemia among adolescents in Denizli, Turkey. Iran J Pediatr 2012; 22 (1): 77-81.
• 5. Pazirandeh S, Burns DL, Motil KJ, et al. Overview of vitamin D Post TW ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com (Last accessed: April 2020).
• 6. Saggese G, Vierucci F, Boot AM, et al. Vitamin D in childhood and adolescence: an expert position statement. Eur J Pediatr 2015; 174(5): 565-576.
• 7. Kaymak Cihan M, Ünver Korğalı E. Is there an association between vitamin D level and iron deficiency in children? Arch Argent Pediatr 2018; 116(6): e736-e743.
• 8. Saab G, Young DO, Gincherman Y, et al. Prevalence of vitamin D deficiency and the safety and effectiveness of monthly ergocalciferol in hemodialysis patients. Nephron Clin Pract 2007; 105(3): c132-138.
• 9. Uwaezuoke SN. Vitamin D deficiency and anemia risk in children: a review of emerging evidence. Pediatric Health Med Ther 2017; 8: 47-55.
• 10. World Health Organization. Hemoglobin concentrations for the diagnosis of anemia and assessment severity. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization, 2011 (WHO/NMH/NHD/MNM/11.1). http://www.who.int/vmnis/indicators/haemoglobin. pdf (Last accessed: April 2020).
• 11. Neyzi O, Bundak R, Gökçay G, et al. Reference Values for Weight, Height, Head Circumference, and Body Mass Index in Turkish Children. J Clin Res Pediatr Endocrinol 2015; 7(4): 280-293.
• 12. Powers JM, Mahoney Jr DH, Drutz JE. Iron deficiency in infants and children <12 years: Treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com (Last accessed: April 2020).
• 13. Spradbrow J, Lin Y, Shelton D, et al. Iron deficiency anemia in the emergency department: over-utilization of red blood cell transfusion and infrequent use of iron supplementation. CJEM 2017; 19(3): 167-174.
• 14. Yoon JW, Kim SW, Yoo EG, et al. Prevalence and risk factors for vitamin D deficiency in children with iron deficiency anemia. Korean J Pediatr 2012; 55(6): 206-211.
• 15. Soliman AT, Al Dabbagh MM, Habboub AH, et al. Linear growth in children with iron deficiency anemia before and after treatment. J Trop Pediatr 2009; 55(5): 324-327.
• 16. Toprak SK, Tek I, Karakuş S, et al. Does Reactive Thrombocytosis Observed in Iron Deficiency Anemia Affect Plasma Viscosity? Turkish J Hematol 2012(3); 29: 248-253.
• 17. Sim JJ, Lac PT, Liu IL, et al. Vitamin D deficiency and anemia: a cross-sectional study. Ann Hematol 2010; 89(5): 447-452.
• 18. Alon DB, Chaimovitz C, Dvilansky A, et al. Novel role of 1,25 (OH) (2) D(3) in induction of erythroid progenitor cell proliferation. Exp Hematol 2002; 30(5):403-409.
• 19. Nebert DW, Wikvall K, Miller WL. Human cytochromes P450 in health and disease. Philos Trans R Soc Lond B Biol Sci 2013; 368 (1612): 20120431.
• 20. Kartal Ö, Kartal AT. Low Vitamin D Levels: Are Associated with Both Iron Deficiency and Anemia in Children and Adolescents? Pediatr Hematol Oncol 2015; 32 (5): 362-363.
• 21. Smith EM, Tangpricha V. Vitamin D and anemia: insights into an emerging association. Curr Opin Endocrinol Diabetes Obes 2015; 22 (6): 432–438.
• 22. Jin HJ, Lee JH, Kim MK. The prevalence of vitamin D deficiency in iron-deficient and normal children under the age of 24 months. Blood Res 2013; 48 (1): 40-45.
• 23. Azizi-Soleiman F, Vafa M, Abiri B, et al. Effects of iron on vitamin D metabolism: a systematic review. Int J Prev Med 2016; 7: 126.
• 24. Sharma S, Jain R, Dabla PK. The Role of 25-Hydroxy Vitamin D Deficiency in Iron Deficient Children of North India. Indian J Clin Biochem 2015; 30 (3): 313-317.