Total Serum Magnesium Levels and Calcium-To-Magnesium Ratio in Sickle Cell Disease.

Charles Antwi-Boasiako,Robert Aryee,Gifty Boatemaah Dankwah,Yaw A Kusi-Mensah,Charles Hayfron-Benjamin,Lim Abla Kwawukume,Ebenezer Owusu Darkwa

doi:10.3390/medicina55090547

Abstract

Background and Objectives: Imbalance of calcium/magnesium ratio could lead to clinical complications in sickle cell disease (SCD). Low levels of magnesium have been associated with sickling, increased polymerization and vaso-occlusion (VOC) in sickle cell due to cell dehydration. The K-Cl cotransport plays a very important role in sickle cell dehydration and is inhibited by significantly increasing levels of magnesium. The study evaluated total serum magnesium levels and computed calcium/magnesium ratio in SCD patients and “healthy” controls. Materials and Methods: The study was a case-control cross-sectional one, involving 120 SCD patients (79 Haemoglobin SS (HbSS)and 41 Haemoglobin SC (HbSC)) at the steady state and 48 “healthy” controls. Sera were prepared from whole blood samples (n = 168) and total magnesium and calcium measured using a Flame Atomic Absorption Spectrometer (Variant 240FS manufactured by VARIAN Australia Pty Ltd., Melbourne, VIC, Australia). Calcium/magnesium ratios were calculated in patients and the controls. Results: The prevalence of hypomagnesemia and hypocalcaemia among the SCD patients was observed to be 39.17% and 52.50% respectively, higher than the controls (4.17% and 22.92%, for hypomagnesemia and hypocalcaemia, respectively). Level of magnesium was significantly lower in the SCD patients compared to their healthy counterparts (p = 0.002). The magnesium level was further reduced in the HbSS patients but not significantly different from the HbSC patients (p = 0.584). calcium/magnesium ratio was significantly higher in the SCD patients (p = 0.031). Although calcium/magnesium ratio was higher in the HbSC patients compared to those with the HbSS genotype, the difference was not significant (p = 0.101). Conclusion: The study shows that magnesium homeostasis are altered in SCD patients, and their levels are lower in HbSS patients. Although calcium/magnesium ratio is significantly higher in SCD patients compared with controls, there is no significant difference between patients with HbSS and HbSC genotypes. Magnesium supplementation may be required in sickle cell patients.

Highlights

Sickle cell disease (SCD) is a group of inherited blood disorders characterized by mutations in the gene that encodes the hemoglobin subunit β (HBB), resulting in the sickle Haemoglobin (HbS) allele βS
Characterized by painful vaso-occlusive crises, intense hemolysis and anemia frequently encountered by sickle cell patients with the HbSS genotype [38,39,40], generally have low levels of magnesium. This could possibly lead to a higher efflux via the Gardos channel and increase cell dehydration [15]. Findings from this current study suggest in part that, there may be similar underlying conditions in the two sickle cell disease (SCD) genotypes studied (HbSS and HbSC), which resulted in the comparable magnesium levels
This study provides an important information on magnesium levels and calcium/magnesium ratio, implicated in the pathophysiology of SCD

Summary

Introduction

Sickle cell disease (SCD) is a group of inherited blood disorders characterized by mutations in the gene that encodes the hemoglobin subunit β (HBB), resulting in the sickle Haemoglobin (HbS) allele βS. Individuals heterozygous for Haemoglobin S and Haemoglobin C (HbSC) present with several complications and this is often described as milder form of the disease [2,3,4]. Previous studies have reported that patients with the HbSC genotype in most cases present a milder form of the disease [5], there has been reports of severe clinical complications in some patients with the HbSC genotype [5,7]. Imbalance of calcium/magnesium ratio could lead to clinical complications in sickle cell disease (SCD). Low levels of magnesium have been associated with sickling, increased polymerization and vaso-occlusion (VOC) in sickle cell due to cell dehydration. The study evaluated total serum magnesium levels and computed calcium/magnesium ratio in SCD patients and “healthy” controls.

Results

Discussion

Conclusion