Background: There is an increased risk of infections in patients with thalassemia compared to general population including urinary tract infections (UTI). The susceptibility to infections in thalassemia arises from iron overload, transfusion therapy, splenectomy, zinc deficiency &disease  itself. all these changes inherent to the pathological process which can interfere with the immune systems

Aims of study: The study was carried out to determine the frequency of urinary tract infection among thalassemic patients, its correlation to risk factors including vaccination, splenectomy, iron overload ,Hb level and to determine microorganism  causing urinary tract infection among thalassemic patients and control group . 

Methods: A case control study was carried out at the Babylon hereditary blood disease center in Babylon Maternity and Children Teaching  Hospital in Hilla / Iraq from March to October 2018 among 100 febrile thalassemic patients as patients group , comparison to 100 febrile non thalassemic patients as control group with age ranging between 6 months -15 years. Urine exam & culture, serum ferritin ,Hb, C-reactive protein, ESR were sent for all patients .

Results: The current study has revealed that 14 % of thalassemic patients developed UTI, in comparison to 5% in non thalassaemic patients .The infection is more among those with low Hb ,incomplete vaccination, splenectomized patients but has no relation to gender &type of thalassemia and E. coli was the commonest microorganism among both group.

Conclusion: This study revealed that the frequency of UTI among febrile thalassemic patients is 14 %, its increased among splenectomized patients, incomplete vaccination and iron overload .

Keywords: thalassemia , urinary tract infection, splenectomy, Immune system, iron overload , vaccination.

1. Boddu A, Kumble A, Mahalingam S, Baliga BS, Achappa B. Pulmonary dysfunction in children with beta thalassemia major in relation with iron overload-a cross sectional hospital based study. Asian Journal of Medical Sciences. 2015 Mar 30;6(5):47-50.‏
2. Ozyoruk D, Misirlioglu ED. Pulmonary functions in children with thalassemia major. Journal of pediatric hematology/ oncology. 2015 Nov 1;37(8):605-10.‏
3. Ginzburg Y, Rivella S. β-thalassemia: a model for elucidating the dynamic regulation of ineffective erythropoiesis and iron metabolism. Blood. 2011 Oct 20;118(16):4321-30.
4. Fraidenburg DR, Machado RF. Pulmonary hypertension associated with thalassemia syndromes. Annals of the New York Academy of Sciences. 2016 Mar 1;1368(1):127-39.
5. Ribeil JA, Arlet JB, Dussiot M, Cruz Moura I, Courtois G, Hermine O. Ineffective erythropoiesis in β-thalassemia. The Scientific World Journal. 2013.
6. Borgna-Pignatti C, Rugolotto SI, De Stefano P, Zhao HU, Cappellini MD, Del  Vecchio GC, Romeo MA, Forni GL, Gamberini MR, Ghilardi RO, Piga AN.     Survival and complications in patients with thalassemia major treated with  transfusion and deferoxamine. Haemato-logica. 2004 Jan 1;89(10):1187-93.
7. Ladis V, Chouliaras G, Berdousi H, Kanavakis E, Kattamis C. Longitudinal study    of survival and causes of death in patients with thalassemia major in Greece.    Annals of the New York Academy of Sciences. 2005 Nov;1054(1):445-50.
8. Quinn CT, Rogers ZR, Buchanan GR. Survival of children with sickle cell disease Blood. 2004 Jun 1;103(11):4023-7.
9. Kehl-Fie TE, Skaar EP. Nutritional immunity beyond iron: a role for manganese and zinc. Current opinion in chemical biology. 2010 Apr 1;14(2):218-24.
10. Walker EM, Walker SM. Effects of iron overload on the immune system. Annals of Clinical & Laboratory Science. 2000 Oct 1;30(4):354-65.
11. Ezer Ü, Gülderen F, Çulha VK, Akgül N, Gürbüz Ö. Immunological status of thalassemia syndrome. Pediatric hematology and oncology. 2002 Jan 1;19(1):51-8.
12. Ricerca BM, Di Girolamo A, Rund D. Infections in thalassemia and hemoglobinopathies: focus on therapy-related complications. Mediterranean journal of hematology and infectious diseases. 2009;1(1).
13. Ahluwalia J, Datta U, Marwaha RK, Sehgal S. Immune functions in splenectomized thalassaemic children. The Indian Journal of Pediatrics. 2000     Dec 1;67(12):871-6.
14. Consolini R, Calleri A, Legitimo A, Massei F. Immunological evaluation of patients with beta-thalassemia major. Actahaematologica. 2001;105(1):7-12.
15. Wiener E. Impaired phagocyte antibacterial effector functions in β- thalassemia: A likely factor in the increased susceptibility to bacterial infections. Hematology. 2003 Jan 1;8(1):35-40.
16. Sinwar PD. Overwhelming post splenectomy infection syndrome–review study. International journal of surgery. 2014 Dec 1;12(12):1314-6.
17. Rahav G, Volach V, Shapiro M, Rund D, Rachmilewitz EA, Goldfarb A. Severe infections in thalassaemic patients: prevalence and predisposing factors. British journal of haematology. 2006 Jun;133(6):667-74.
18. Marques RG. Sepsis and the Spleen. The Spleen. 2011:84.
19. Haley KP, Skaar EP. A battle for iron: host sequestration and Staphylococcus    aureus acquisition. Microbes and Infection. 2012 Mar 1;14(3):217-27.
20. Salvatore s , cattoni E ,Siesto G, Serati M (June 2011 ). Urinary tract    infection in women. European journal of Obstetrics, Gynecology and reproductive Biology 156(2):131- doi:10.1016/i.ejogrb.2011.01.028.PMID 21349630

Fawaz Mutlaq

Dr Ahmed Shemran Mutlaq Al-Wataify

Professor of Pediatrics, Department of Pediatrics, Collage of Medicine, Babylon University, Iraq