Zinc and copper in transfusion-dependent thalassemia patients on different iron chelators in Basrah: A case-control study

Background: Disturbances induced by chelating agents in the essential metal ions, including zinc and copper, can adversely impact the health of patients with transfusion-dependent thalassemia (TDT). Objectives: The aim of this study was to investigate the effect of different iron chelators on the levels of zinc and copper among patients with TDT. Materials and Methods: This case-control study involved 94 patients with TDT and 59 healthy controls, their ages ranged from 5 to 37 years. Patients with TDT were subdivided into two groups: 51 patients were on deferasirox and 43 were on deferoxamine. Blood samples were collected from all participants for complete blood counts and serum ferritin, iron, zinc, and copper levels, which were determined by spectrophotometry. Results: Serum iron, ferritin, and zinc levels were significantly higher among patients with TDT, while the Hb level was significantly lower than that in the healthy population (P < 0.05). Serum copper levels did not differ significantly between the groups. A high frequency of zinc deficiency was reported among patients with TDT on deferasirox (56.9%) and control group (47.5%), compared to 16.3% for patients with TDT on deferoxamine (P < 0.001). For serum copper, most of them had normal levels (81.4%–90.2%). Patients on deferoxamine had significantly higher serum zinc and copper levels than those on deferasirox and control group, although the mean serum values were within the normal range of values for the three groups (P < 0.01). Conclusions: Low serum zinc was reported in a considerable percentage of patients with TDT receiving deferasirox compared to those receiving deferoxamine, while serum copper was within normal range in the majority of patients with TDT.