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Leukemia is a blood cancer in which there is an excess production of abnormal leukocytes, that is made up of several diverse and biologically distinct subgroups. Acute lymphoblastic leukemia (ALL) is the most prevalent form of cancer in children and…
Leukemia is a blood cancer in which there is an excess production of abnormal leukocytes, that is made up of several diverse and biologically distinct subgroups. Acute lymphoblastic leukemia (ALL) is the most prevalent form of cancer in children and predominant subtype of childhood leukemia. It represents a malignant expansion of immature lymphoid cells.
This study has been performed to estimate the serum levels of iron profile, hematological and immunological parameters in newly diagnosed acute lymphoblastic leukemia patients. It also investigates the correlations of iron state indices with the hematological alterations and immunological parameters in ALL patients.
This study was conducted on (90) subjects of children, their ages ranged between (1-8 years)' children, and they are divided into two groups: (60) newly diagnosed untreated acute lymphoblastic leukemia patients (32 male and 28 female) who visited the National Hospital to Oncology and Hematology Disease in Al-Najaf and the National Center for Educational Laboratories - Department of Hematology / Medical City of Baghdad, and (30) individuals (16 male and 14 female) apparently healthy as a control group. The study was carried out between the period of December, 2023 till February, 2025.
The results showed a significant decrease (P < 0.05) in serum iron and serum total-iron binding capacity (TIBC) levels in ALL patients compared to those of healthy control group, while serum ferritin, hepcidin and transferrin levels significantly increased (P < 0.05) in patients with ALL compared to the control group.
The results also have reported a significant elevation (P < 0.05) in total leukocyte count and lymphocyte percentage in the acute lymphoblastic leukemia patients, whereas the percentage of neutrophils declined significantly (P < 0.05) in the patient group compared with their count in control group.
The findings of this study indicate also a significant decrease (P < 0.05) in the red blood corpuscle (RBC) count, hemoglobin concentration (HGB), hematocrit (HCT) value, RBC indices (mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC)) and platelet count in recently diagnosed ALL patients in comparation with the control group.
The levels of cluster of differentiation 19 (CD19) and cluster of differentiation 34 (CD34) expression were noted to be have a difference between the study groups, but this difference was not significant. Whereas, the levels of interleukin 18 (IL18) and interleukin 35 (IL35) manifested a significant increase (P < 0.05) in the ALL group compared with the normal children.
The results of study showed there is no significant difference (P > 0.05) between males and female patients in iron profile, hematological parameters and immunological criteria.
The correlations result showed significant positive correlation (p < 0.05) between serum iron and neutrophils, RBC count, HGB, HCT, RBC indices and PLT count. While iron showed a significant inverse correlation (p < 0.05) with white blood cell (WBC) count, lymphocytes, IL18 and IL35 in the acute lymphoblastic leukemia patients. Whereas CD19 and CD34 showed not significant correlation (P > 0.05) with iron in those patients.
The serum ferritin and hepcidin in the ALL patients showed a positive correlation with WBCs, lymphocytes, CD19, CD34, IL18 and IL35; but it showed a negative correlation with neutrophils, RBCs, HGB, HCT, RBC indices, PLTs.
Additionally, the statistical analysis showed that transferrin in patients with ALL has positive correlation with WBCs, Lymphocytes, IL18 and IL35. However, it showed a negative correlation with neutrophils, RBCs, HGB and HCT, RBC indices and PLTs. Whereas CD19 and CD34 not appeared a significant correlation (P > 0.05) with transferrin in ALL patients.
Moreover, the serum TIBC in the ALL correlated positively with neutrophils, RBCs, HGB, HCT, RBC indices and PLTs; and has inverse correlation with WBC count, lymphocytes, CD19, CD34, IL18 and IL35.
The receiver operating curve (ROC) analysis and area under the curve (AUC) to discriminated by the area under curve and cut-off point between ALL patients and controls showed highly significant (p-value <0.05) of area under curve in iron, Ferritin and Hepcidin followed by Transferrin then TIBC. In similar results of ROC analysis and AUC in the same patients and controls explained that IL18, followed by IL35, more than CD34, while CD19 were showed has AUC is low diagnostic accuracy.
The current study concluded that ALL patients exhibited iron deficiency with defect in iron metabolism, leukocytosis, lymphocytosis, anemia, thrombocytopenia, Pro-inflammatory cytokine elevation with presence various correlations between iron profile with hematological and immunological parameters.
