Natural Anticoagulants in Transfusion Dependent Beta-Thalassemia Patients

Abstract Background Thromboembolic events have been recorded in Beta-Thalassemia Patients. Several etiologic factors may play a role in the pathogenesis of the hypercoagulable state in thalassemia among which is decreased levels of naturally occurring anticoagulants such as protein C, protein S and anti-thrombin III. Objective To evaluate levels of naturally occurring anticoagulants in transfusion dependent beta-thalassemia patients and to assess the relationship between natural anticoagulants levels and the risk for thromboembolic complications among these patients. Patients and Methods This case control study included 40 transfusion dependent beta-thalassemia patients and 40 healthy participants as controls. Patients were recruited and assessed for eligibility from Ain Shams University Haematology unit. Protein C%, anti-thrombin-III (AT III) % and protein S% levels were measured and their correlations to liver enzymes were evaluated. Results The mean level of protein C (77.0%), protein S (79.50%) and AT III (90.0%) were significantly reduced in patients' group in comparison with control subjects (p-value <0.001). These findings were significantly positively corelated withthrombotic events, age, transfusion index, platelets count, serum ferritin, and aspartate transaminase (p < 0.05). Type of the chelation therapy, splenectomy, T2 star liver, T2 star heart, serum creatinine and albumin did not affect significantly the serum levels of the studied natural anticoagulants (p > 0.05). Conclusion Natural anticoagulants namely protein C, protein S and anti-thrombin III were significantly reduced among transfusion dependent beta-thalassemic patients which seem to contribute to the increased risk of thromboembolic events in these patients. This study supports the use of early prophylactic anti-coagulant therapy for this high-risk group.