| Objective: To investigate the correlation between plasma antithrombin Ⅲ(AT-Ⅲ),Ddimer(D-D)and blood transfusion volume,iron overload in children with β-thalassemia major,and to provide a theoretical basis for standardizing clinical blood transfusion,removing iron and early prediction of blood hypercoagulability and preventing thrombosis in children with β-thalassemia major.Methods:(1)Inclusion criteria and grouping methods: 58 children with β-thalassemia major admitted to the Department of Pediatrics,Affiliated Hospital of Youjiang Medical University for Nationalities from September 2020 to September 2021 were randomly selected,aged from 2 to 14 years,and continuously treated repeatedly for at least 1 year.They were divided into three groups according to two dimensions:(1)11 cases in the low blood transfusion group,28 cases in the conventional blood transfusion group and 19 cases in the high blood transfusion group according to different blood transfusion levels,with a total of three groups;(2)23 cases in the < 2000 μg/L group,20 cases in the 2000 ～ 5000 μg/L group,and 15 cases in the > 5000 μg/L group according to different serum ferritin(SF)content levels,with a total of three groups;(3)22 children who visited the Department of Child Health of our hospital during the same period were randomly selected as the healthy control group.(2)Collect the clinical data of sex,age,weight,thalassemia β gene type,blood routine,serum ferritin,blood transfusion volume and routine laboratory tests.(3)Enzyme-linked immunosorbent assay(ELISA)was used to determine the plasma levels of AT-Ⅲ and D-D in the enrolled subjects.(4)SPSS 27.0 was used for statistical comparison of differences between groups.Results:(1)Plasma AT-Ⅲ: In different groups of blood transfusion volume levels: there was a significant difference in plasma AT-Ⅲ levels between the high blood transfusion group and the control group and the conventional blood transfusion group(P < 0.05),as shown by the control group > the conventional blood transfusion group > the high blood transfusion group;there was no significant difference in plasma AT-Ⅲ levels between the low blood transfusion group and the conventional blood transfusion group,the high blood transfusion group,and the control group(P > 0.05).In different groups of SF content levels: there was a significant difference in plasma AT-Ⅲ levels between the control group and the 2000 ～ 5000 μg/L and >5000 μg/L groups(P < 0.05),as shown by the fact that the 2000 ～ 5000 μg/L group was smaller than the control group and the > 5000 μg/L group was smaller than the control group;there was a significant difference in plasma AT-Ⅲ levels between the < 2000 μg/L group and the 2000 ～5000 μg/L and > 5000 μg/L groups(P < 0.05),as shown by the fact that the < 2000 μg/L group was greater than the 2000 ～ 5000 μg/L group and the < 2000 μg/L group was greater than the >5000 μg/L group;there was no significant difference in plasma AT-Ⅲ levels between the control group and the < 2000 μg/L group(P > 0.05);there was no significant difference in plasma ATⅢ levels between the 2000 ～ 5000 μg/L group and the > 5000 μg/L group(P > 0.05).(2)Plasma D-D: In different groups of blood transfusion volume levels: there was a significant difference in plasma D-D levels between the control group and the low blood transfusion group and the high blood transfusion group(P < 0.05),as shown by the fact that the high blood transfusion group and the low blood transfusion group were greater than the control group;there was a significant difference in plasma D-D levels between the conventional blood transfusion group and the high blood transfusion group(P < 0.05),as shown by the high blood transfusion group >the conventional blood transfusion group;there was no significant difference in plasma D-D levels between the low blood transfusion group and the high blood transfusion group and the conventional blood transfusion group(P > 0.05).In different groups of SF content levels: there was a significant difference in plasma D-D levels between the control group and the < 2000μg/L and > 5000 μg/L groups(P < 0.05),showing that the < 2000 μg/L and > 5000 μg/L groups were greater than the control group;there was a significant difference in plasma D-D levels between the < 2000 μg/L group and the 2000 ～ 5000 μg/L and > 5000 μg/L groups(P < 0.05),showing that the 2000 ～ 5000 μg/L and > 5000 μg/L groups were greater than the < 2000 μg/L group;there was no significant difference in plasma D-D levels between the 2000 ～ 5000 μg/L and > 5000 μg/L groups(P > 0.05).(3)Correlation analysis between observation indicators: In different groups of blood transfusion volume levels: plasma AT-Ⅲ was positively correlated with platelet(PLT)and white blood cell(WBC)in the low blood transfusion group(r > 0,P <0.05),plasma AT-Ⅲ was not significantly correlated with D-D and SF(P > 0.05),and plasma D-D was not significantly correlated with SF,WBC and PLT(P > 0.05);plasma AT-Ⅲ and DD were not significantly correlated with SF,WBC and PLT in the conventional blood transfusion group(P > 0.05);plasma D-D was positively correlated with SF in the high blood transfusion group(r > 0,P < 0.05),plasma D-D was negatively correlated with AT-Ⅲ(r < 0,P< 0.05),plasma AT-Ⅲ was positively correlated with SF(r > 0,P < 0.05),and plasma AT-Ⅲ was not significantly correlated with WBC and PLT(P > 0.05).There was no significant correlation between plasma D-D and WBC,PLT(P > 0.05).In different groups of SF content levels: plasma D-D was positively correlated with SF in the > 5000 μg/L group(r > 0,P < 0.05),plasma AT-Ⅲ was not significantly correlated with D-D,WBC,PLT,and SF(P > 0.05),and plasma D-D was not significantly correlated with PLT and WBC(P > 0.05);plasma AT-Ⅲ and D-D were not significantly correlated with SF,WBC,and PLT in the < 2000 μg/L group(P >0.05);plasma AT-Ⅲ and D-D were not significantly correlated with SF,WBC,and PLT in the2000 ～ 5000 μg/L group(P > 0.05).Conclusion:(1)Plasma AT-Ⅲ is positively correlated with PLT and WBC in children withβ-thalassemia major at low blood transfusion volume,and the possibility of WBC and PLT decrease is greater when plasma AT-Ⅲ levels decrease;(2)Plasma AT-Ⅲ is lower,D-D and SF are higher,and D-D is positively correlated with SF in children with β-thalassemia major at high blood transfusion volume,and when SF > 5000 μg/L,it may increase the risk of blood hypercoagulability or thromboembolism,and conventional blood transfusion therapy can reduce this risk;(3)When SF ≥ 2000 μg/L,plasma AT-Ⅲ levels are decreased in children with β-thalassemia major,and when SF > 5000 μg/L,D-D levels increase more significantly,and iron overload is a possible factor for increasing the formation of blood hypercoagulability or thromboembolism;(4)Appropriate conventional blood transfusion and effective iron therapy can reduce the risk of blood hypercoagulability or thromboembolism in children with β-thalassemia major. |
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