The effects of chelators on zinc levels in patients with thalassemia major

Zinc which is an essential element has very important effects on growth and immune system in patients with thalassemia major (TM). The effects of two oral iron chelator agents, desferrioxamine (DFO) and deferiprone (DFP), on zinc levels were investigated in previous studies and they were found to cause zinc deficiency. Zinc level alteration by the new chelator deferasirox (DFX) is not present in the literature. The aim of this study was to examine the effects of different oral chelators on serum and urine zinc levels in TM patients. Zinc levels are compared in the patients who received different chelators: only DFX, combined chelation with DFO plus DFP and the healthy control group. A total of 56 patients with TM were involved in this study: 39 patients received only DFX and 17 patients were given combined treatment DFO + DFP between August 2008 and August 2009. In addition, a control group was established from the healthy population. Blood was taken from all the patients for serum zinc levels and 24 hour-urine samples were collected for urine zinc levels. Serum zinc levels were found to be 64.8 ± 14.8 μg/dL in DFX group and 66.5 ± 15.1 μg/dL in DFO + DFP group. These levels were statistically lower than that in the control group (149 ± 54.3 μg/dL) (p < 0.05), but there was no statistically difference between the two different chelation groups (p > 0.05). The urine zinc levels of DFX and DFO + DFP group were 662.2 ± 428.2 μg/day and 1182.3 ± 980.3 μg/day respectively (p < 0.05). Urinary zinc excretion in the chelation groups (DFX and DFO + DFP) was significantly higher than the control group (395.1 ± 208.9 μg/day) (p < 0.05). As a conclusion, the new chelation agent, DFX, also leads to zinc deficiency, though its urinary zinc excretion is lower. New studies are required to examine the effects of DFX on zinc extensively. Zinc levels of patients with TM should be followed up regularly and zinc supply should be given at early ages.