Increased relative lymphocyte number with reduced mature activated T-lymphocytes (CD3+CD69+) in stunted iron overloaded major beta-thalassemia patients

M. Ghozali; S. Praptama; Kinjal Andrade; Adi Imam Tjahjadi; Lelani Reniarti; Budi Setiabudiawan; Ramdan Panigoro

M. Ghozali Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Indonesia
S. Praptama Faculty of Medicine, Universitas Padjadjaran, Indonesia
Kinjal Andrade Faculty of Medicine, Universitas Padjadjaran, Indonesia. Maharashtra Institute of Medical Education and Research, India
Adi Imam Tjahjadi Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Indonesia
Lelani Reniarti Department of Pediatrics, Faculty of Medicine, Universitas Padjadjaran, Indonesia
Budi Setiabudiawan Department of Pediatrics, Faculty of Medicine, Universitas Padjadjaran, Indonesia
Ramdan Panigoro Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Indonesia

Abstract

Alteration of immune response as either the consequence or cause of growth retardation is one of the common complication found in major beta-thalassemia patients, which may lead them to be susceptible to infection. T-lymphocytes harboring CD69 following their activation are central elements of the immune system. A cross-sectional analytical study applying multicolor flowcytometry aimed to characterize T-lymphocytes surface protein of asymptomatic 51 pediatric major beta-thalassemia patients routinely visit Hasan Sadikin General Hospital for routine blood transfusion linked to their growth status, iron level, and hematology profile were done. Nutritional status was assessed by height-for-age z-score. Serum iron, total iron‐binding capacity (TIBC), serum transferrin, and serum ferritin were measured. Hemoglobin concentration, mean corpuscular volume, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration were also measured. Respectively, 41% and 22% of the population showed stunted and severely stunted growth. Stunted major beta-thalassemia patients showed a significant higher differential count of lymphocyte (p = 0.02) than well-nourished patients. Compared to well-nourished major beta-thalassemia patients, significant reduced CD3+CD69+ T-lymphocyte population (p = 0.04) while higher TIBC level (p < 0.0001) were found. However, TIBC level of stunted major beta-thalassemia patients was significantly lower (p < 0.0001) than in severely stunted patients. In conclusion, a chronic inflammatory disorder accompanied with cellular immunological defect revealed in undernourished besides double burdened by iron overload is a serious health problem in major beta-thalassemia patients and this preliminary study makes it even more pronounced. Further investigation in characterizing the T-lymphocyte subsets and cytokines involved in malnourished major beta-thalassemia patients is imperative to be carried out.

Keywords: Thalassemia major; T-lymphocyte; CD3+CD69+; stunting