Acute effects of blood transfusion on growth hormone and insulin-like growth factor-1 levels in children with thalassemia.
OBJECTIVE
Children with β-thalassemia have chronic anemia and growth retardation. Impaired growth hormone (GH)-insulin-like growth factor-1 (IGF-1) axis function has been demonstrated. Growth improvement has been demonstrated following optimal blood transfusion. Whether correction of anemia by blood transfusion augments GH-IGF-1 axis function has not been established.


METHODS
Twenty children with thalassemia aged 11.7 years (5.3-16.3 years) were recruited. GH provocative tests were performed twice, before and 1 week after blood transfusion. IGF-1, IGF-binding protein-3 (IGFBP-3) and hematocrit were measured.


RESULTS
Median IGF-1 and IGFBP-3 concentrations were significantly increased at 1 week following transfusion: pre- versus posttransfused concentrations: 86.4 versus 143.5 ng/ml (p < 0.001) and 2.95 versus 3.75 mg/l (p < 0.001), respectively. However, median peak GH levels and areas under the curve of GH during GH testing between pre- and posttransfusion periods were not different. The pretransfused hematocrit level was correlated with pretransfused IGF-1 (r = 0.662, p < 0.001) and IGFBP-3 (r = 0.691, p < 0.001) levels.


CONCLUSIONS
In thalassemics, correction of anemia by blood transfusion rapidly enhanced GH-mediated IGF-1 and IGFBP-3 secretion. This suggests thatanemia may be one of the factors causing partial GH insensitivity.
Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. rapmw@mahidol.ac.th
Pat
P
Mahachoklertwattana
Titiya
T
Yimsumruay
Preamrudee
P
Poomthavorn
Ampaiwan
A
Chuansumrit
Patcharin
P
Khlairit
D000293:Adolescent; D000740:Anemia / Q000209:etiology / Q000503:physiopathology; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D003000:Clonidine; D003430:Cross-Sectional Studies; D005260:Female; D006130:Growth Disorders / Q000209:etiology / Q000503:physiopathology; D006400:Hematocrit; D019382:Human Growth Hormone / Q000097:blood* / Q000378:metabolism; D006801:Humans; D018972:Insulin-Like Growth Factor Binding Protein 3; D018969:Insulin-Like Growth Factor Binding Proteins / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000032:analysis*; D007700:Kinetics; D008099:Liver / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D010902:Pituitary Gland / Q000187:drug effects / Q000503:physiopathology; D017086:beta-Thalassemia / Q000097:blood* / Q000503:physiopathology / Q000628:therapy*
C515497:IGFBP3 protein, human; D018972:Insulin-Like Growth Factor Binding Protein 3; D018969:Insulin-Like Growth Factor Binding Proteins; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D003000:Clonidine