Vitamin D deficiency and elevation of para-thyroid in Thalassemia minor: a case study

S. Debnath

βThalassemia Minor cases unlike Thal-Major don’t require immediate medical attention, due to effective compensatory haematopoiesis and remain transfusion independent and patients may remain metabolically deficient lowering quality of life. To impose an artificial genetic bottleneck and suppress the dispersion of Thal-minor and Thal-major mutationsas in a population early detection is the only way out. Hypocholestreloemia, Vitamin D deficiency and marginally elevated Parathyroid hormone may be found in Thal-minors as reported in the case study. Absence of significant anaemia may make the condition cryptic or latent, delaying diagnosis of the condition and the situation may be complicate in longterm. Parathyroid level may be evaluated for secondary hyperparathyroidism due to deficiency of vitamin D. If several findings of Ca crystals (++/+) are present in urine RE, Bisphosphonate therapy may provide relief. This case study reports occurrence of pancreatic insufficiency, resultant steatorrhoea, Vitamin D (25-OH) deficiency (13.86 ng/ml) with Hypocholesterolemia (85 mg/dl). Para thyroid hormone was in upper limit (62 pg/ml) and Ca+2 was 9.5 mg/ml in a 30 years old male Thal-minor patient (fetal hemoglobin 2.10%, HbA2 4.60% and Hb Adult 84.80%).

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Table 1 Some diagnostic parameters of the patient case
Hematological profile	Endocrineand related parameters profile	Serum enzymes	Serum anti bodies	Metabolic parameters and vitamin profile	Minerals and electrolytes
Hemoglobin 13.8 mg/dl	Para thyroid hormone 62 pg/ml	SGPT 333 IU/ml	Anti CCP antibody negative	F sugar 85 mg/dl	Serum calcium was moderately low at 8.6 mg/dl
Reticulocyte count 1.08%	Serum aldosterone 304.99 pg/ml	Alk phos 400 IU/ml	ANA negative	PP sugar 100 mg/dl	Serum bi-carbonate moderaly elevated at 63 mmol
Fetal hemoglobin 2.10%	Erythropoietin 22.80 mIU/ml		CRP negative	Total cholesterol 80 mg/dl	Serum chloride WNR
HbA2 4.60%	Homocysteine 11.97 μmol/l			HbA1c was 5.60%	Serum sodium WNR
Hb adult 84.80%	TSH WNR			Total bilirubin 3 mg/dl	Serum potassium was 5 mg/dl
TIBC was normal	FT₃ WNR			Total protein 6 mg/dl
First hour ERS 08 mm (Westergren)	FT⁴ WNR			Vitamin B 12 level 466 pg/ml
TC of WBC 6900/ cm	Urine osmolarity 295 mmol/kg			Folic acid level 14.15 ng/ml
DLC WNR	Urine volume 3560 ml/24 h			Vitamin D (25 OH) 13.86 ng/ml
	Creatinie clearance was 117 ml/min			72 h stool fat was estimated to be 25.6 g
				132 mg/dl protein excreted in 24 h
WNR - with in normal range for Indian males.

Endocrine Abstracts

P413