Relationship between Pain and Serum Ferritin Levels in Adult Transfusion-Dependent Thalassemia

Shenny Dianathasari Santoso, Uni Gamayani, Asep Nugraha Hermawan, Pandji Irani Fianza, Aih Cahyani, Lisda Amalia, Yusuf Wibisono, Ramdan Panigoro

Abstract


Patients with transfusion-dependent thalassemia (TDT) may experience an increase in ferritin due to shorter erythrocyte lifespan and lysis, as well as side effects of transfusion. Increasing ferritin can cause various complications, including pain, which can develop into chronic pain and interfere with life quality. This study aims to determine the relationship between pain and serum ferritin levels in adults with TDT. This study was an analytical observational study using a cross-sectional design on adult TDT patients with pain who came to the Hemato-Oncology Clinic of Dr. Hasan Sadikin General Hospital Bandung. This research was conducted from March to June 2021. All subjects were assisted to fill out the Indonesian version of the Brief Pain Inventory Short Form (BPI-SF) questionnaire before transfusion. Ferritin levels in the last three months were obtained from medical records. If more than three months, serum ferritin levels were examined. Ferritin levels and BPI-SF scores were then correlated using the Pearson test. The study was conducted on 51 adult TDT patients with pain, and the average value of ferritin levels in research subjects is 5081±2929 g/L. There was a relationship between pain (the dimensions of pain interfere with life on the BPI-SF score) and an increase in ferritin levels (p=0.042, r=0.29). The results showed there is a relationship between pain and serum ferritin levels. Regular consumption of iron chelation tablets can reduce ferritin levels and improve the quality of life for adults with TDT.

 

HUBUNGAN NYERI DENGAN KADAR FERITIN SERUM PADA PENYANDANG TRANSFUSION-DEPENDENT THALASSEMIA DEWASA

Penyandang transfusion-dependent thalassemia (TDT) dapat mengalami peningkatan feritin akibat umur eritrosit yang lebih pendek dan mudah lisis, serta efek samping terhadap pemberian transfusi. Peningkatan feritin tersebut dapat menyebabkan berbagai komplikasi di antaranya nyeri yang dapat berkembang menjadi nyeri kronik dan mengganggu kualitas hidup. Penelitian ini bertujuan mengetahui hubungan nyeri dengan kadar feritin serum pada penyandang TDT dewasa. Penelitian dengan observasional analitik menggunakan rancangan potong lintang pada penyandang TDT dewasa dengan nyeri yang datang ke Klinik Hemato-Onkologi RSUP Dr. Hasan Sadikin Bandung. Penelitian dilakukan dari Maret hingga Juni 2021. Seluruh subjek dilakukan pendampingan untuk mengisi kuesioner Brief Pain Inventory Short Form (BPI-SF) versi Indonesia sebelum transfusi. Kadar feritin dalam tiga bulan terakhir didapatkan dari rekam medis dan bila lebih dari tiga bulan dilakukan pemeriksaan kadar feritin serum. Kadar feritin dan skor BPI-SF kemudian dikorelasikan menggunakan Uji Pearson. Penelitian dilakukan kepada 51 penyandang TDT dewasa dengan gejala nyeri dan didapatkan nilai rerata kadar feritin pada subjek penelitian adalah 5081±2929 μg/L. Hasil penelitian memperlihatkan terdapat hubungan antara nyeri (dimensi efek nyeri terhadap kehidupan) dan peningkatan kadar feritin (p=0,042; r=0,29). Hasil penelitian menunjukkan terdapat hubungan antara nyeri dan kadar feritin serum. Konsumsi tablet kelasi besi secara rutin dapat menurunkan kadar feritin dan memperbaiki kualitas hidup penyandang TDT dewasa.


Keywords


Feritin; ferritin; nyeri; pain; thalassemia

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References


Tubman VN, Fung EB, Vogiatzi M, Thompson AA, Rogers ZR, Neufeld EJ, et al. Guidelines for the standard monitoring of patients with thalassemia: report of the Thalassemia Longitudinal Cohort. J Pediatr Hematol Oncol. 2015;37(3):e162–9.

Galanello R, Origa R. Beta-thalassemia. Orphanet J Rare Dis. 2010;5:11.

Viprakasit V, Ekwattanakit S. Clinical classification, screening and diagnosis for thalassemia. Hematol Oncol Clin North Am. 2018;32(2)193–211.

Lal A. Assessment and treatment of pain in thalassemia. Ann N Y Acad Sci. 2016;1368(1):65–72.

Halon-Golabek M, Borkowska A, Herman-Antosiewicz A, Antosiewicz J. Iron metabolism of the skeletal muscle and neurodegeneration. Front Neurosci. 2019;13:165.

Fu K, Robbins SR, McDougall JJ. Osteoarthritis: the genesis of pain. Rheumatology (Oxford). 2018;57(Suppl 4):iv43–50.

Cappellini MD, Cohen A, Porter J, Taher A, Viprakasit V. Guidelines for the management of transfusion dependent thalassaemia (TDT). 3rd Edition. Nicosia: Thalassaemia International Federation; 2014.

Oliveros O, Trachtenberg F, Haines D, Gerstenberger E, Martin M, Carson S, et al. Pain over time and its effects on life in thalassemia. Am J Hematol. 2013;88(11):939–43.

Whalen NL, Olynyk JK. Association of transferrin saturation with the arthropathy of hereditary hemochromatosis. Clin Gastroenterol Hepatol. 2017;15(10):1507–8.

Sawaya RA, Zahed L, Taher A. Peripheral neuropathy in thalassemia. Ann Saudi Med. 2006;26(5):358–63.

Tracey I, Woolf CJ, Andrews NA. Composite pain biomarker signatures for objective assessment and effective treatment. Neuron. 2019;101(5):783–800.

Goubert D, Meeus M, Willems T, De Pauw R, Coppieters I, Crombez G et al. The association between back muscle characteristics and pressure pain sensitivity in low back pain patients. Scand J Pain. 2018;18(2):281–93.

Cohen M, Quintner J, van Rysewyk S. Reconsidering the International Association for the Study of Pain definition of pain. Pain Rep. 2018;3(2):e634.

Perisano C, Marzetti E, Spinelli MS, Callà CAM, Graci C, Maccauro G. Physiopathology of bone modifications in β-thalassemia. Anemia. 2012;2012:320737.

Karimi M, Zarei T, Pishdad P. Extramedullary hematopoiesis in a patient with transfusion dependent beta-thalassemia presenting with cord compression. IJBC. 2018;10(1):28–30.

Moiz B, Khan HA, Raheem A, Shariq M. High prevalence of bone pain and fractures in young transfusion dependent patients with β-thalassemia at Southern Pakistan. Ann Hematol Oncol. 2019;6(2):1234.

Allegri M, Montella S, Salici F, Valente A, Marchesini M, Compagnone C, et al. Mechanism of low back pain: a guide for diagnosis and therapy. F1000Res. 2016;5(F1000 Faculty Rev):1530.

Wiitavaara B, Fahlström M, Djupsjöbacka M. Prevalence, diagnostics and management of musculoskeletal disorders in primary health care in Sweden – an investigation of 2000 randomly selected patient records. J Eval Clin Pract. 2017;23(2):325–32.

Primorac D, Molnar V, Rod E, Jeleč Z, Čukelj F, Matišić V, et al. Knee osteoarthritis: a review of pathogenesis and state-of-the-art non-operative therapeutic considerations. Genes (Basel). 2020;11(8):854.

Onwuasoanya A. Pain management and assessment for healthcare practitioners: review article. J Anesth Pain Med. 2016;1(2):00002.

Bonafé FSS, de Campos LA, Marôco J, Campos JADB. Brief Pain Inventory: a proposal to extend its clinical application. Eur J Pain. 2019;23(3):565–76.

Majedi H, Dehghani SS, Soleyman-Jahi S, Emami Meibodi SA, Mireskandari SM, Hajiaghababaei M, et al. Validation of the Persian version of the Brief Pain Inventory (BPI-P) in chronic pain Patients. J Pain Symptom Manage. 2017;54(1):132–8.

Poquet N, Lin C. The Brief Pain Inventory (BPI). J Physiother. 2016;62(1):52.

Oliveros O, Trachtenberg F, Haines D, Gerstenberger E, Martin M, Carson S, et al. Pain over time and its effects on life in thalassemia. Am J Hematol. 2013;88(11):939–43.

Fraenkel L, Falzer P, Fried T, Kohler M, Peters E, Kerns R, et al. Measuring pain impact versus pain severity using a numeric rating scale. J Gen Intern Med. 2012;27(5):555–60.

Markman JD, Gewandter JS, Frazer ME. Comparison of a Pain Tolerability Question with the Numeric Rating Scale for assessment of self-reported chronic pain. JAMA Netw Open. 2020;3(4):e203155.

Bendinger T, Plunkett N. Measurement in pain medicine. BJA Educ. 2016;16(9):310–5.

Porter JL, Rawla P. Hemochromatosis. Treasure Island: StatPearls Publishing; 2020.

Bhardwaj P, Yadav R. Measuring pain in clinical trials: pain scales, endpoints, and challenges. Int J Clin Exp Physiol. 2015;2(3):151–6.




DOI: https://doi.org/10.29313/gmhc.v9i3.8787

pISSN 2301-9123 | eISSN 2460-5441


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