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. 2022 Jul 15;14(7):4743-4756.
eCollection 2022.

Phosphatidylserine-exposed red blood cells and ineffective erythropoiesis biomarkers in patients with thalassemia

Siriyakorn Chansai  1   2 , Supawadee Yamsri  2 , Supan Fucharoen  2 , Goonnapa Fucharoen  2 , Nattiya Teawtrakul  3
Affiliations

Phosphatidylserine-exposed red blood cells and ineffective erythropoiesis biomarkers in patients with thalassemia

Siriyakorn Chansai et al. Am J Transl Res. .

Abstract

Objective: The degree of ineffective erythropoiesis is known to be associated with clinical severity among individuals with thalassemia. The association of ineffective erythropoiesis biomarker levels with different thalassemia genotypes, however, remains limited. The aim of this study was to explore the level of phosphatidylserine-exposed red blood cells (PS-exposed RBCs) and ineffective erythropoiesis biomarkers (growth-differentiation factor-15 and soluble transferrin receptors) in patients with different genotypes.

Methods: A cross-sectional study was conducted on 139 patients of age 18 years and above with different genotypes at Srinagarind Hospital, Khon Kaen University, Thailand. The levels of PS-exposed RBCs were determined using flow cytometry. Measurements of growth-differentiation factor-15 (GDF-15) and soluble transferrin receptors (sTfR) were evaluated by the ELISA method.

Results: The PS-exposed RBCs levels were found to be significantly higher in splenectomized beta-thalassemia patients. Patients with beta-thalassemia had the highest GDF-15 levels, followed by patients with non-deletional alpha-thalassemia. Patients with non-deletional alpha-thalassemia showed elevated hemoglobin levels and reduced GDF-15 levels after splenectomy. Patients with beta-thalassemia and non-deletional alpha-thalassemia had the highest levels of PS-exposed RBCs and ineffective erythropoiesis biomarkers, which correlated with the clinical severity of thalassemia.

Conclusions: The levels of ineffective erythropoiesis biomarkers were different across thalassemia genotypes. Splenectomy may improve clinical symptoms of patients with non-deletional alpha thalassemia but not of patients with beta-thalassemia. These findings demonstrate differences in the degree of ineffective erythropoiesis in thalassemia, which emphasizes the need for different treatment approaches among patients with different thalassemia genotypes.

Keywords: Phosphatidylserine exposed red blood cells; ineffective erythropoiesis biomarkers; thalassemia.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Graph box of phosphatidylserine-exposed red blood cells (PS-exposed RBCs), growth-differentiation factor-15 (GDF15), and soluble transferrin receptors (sTFR) levels in patients with thalassemia by genotype group.
Figure 2
Figure 2
Graph box of PS-exposed RBCs, GDF15, sTFR, Hb level, and liver iron concentration (LIC) in patients with thalassemia by splenectomy status. (A) PS-exposed RBCs levels by splenectomy status, (B) GDF15 levels by splenectomy status, (C) sTFR levels by splenectomy status, (D) Hb levels by splenectomy status, and (E) LIC by splenectomy status.
Figure 3
Figure 3
Graph box of PS-exposed RBCs, GDF15, sTFR, Hb levels and LIC in patients with thalassemia by RBC transfusion status. (A) PS-exposed RBCs level by RBC transfusion status, (B) GDF15 level by RBC transfusion status, (C) sTFR level by RBC transfusion status, (D) Hb level by RBC transfusion status, and (E) LIC by RBC transfusion status.
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