studies on human fascioliasis in egypt 2. serum iron and copper 1n ...

Journal of the Egyptian Society of Parasitology, Vol. 23, No. 2, August 1993
STUDIES ON HUMAN FASCIOLIASIS IN EGYPT
2. SERUM IRON AND COPPER 1N CHRONIC FASCIOLIASIS
AZIZA SALEM', MERVAT OSMAN', MONA KANDIL', MONA ABAZA'
and SAMIA ELEWA:'
Departments of Parasitology1, Clinzcal Pathology: Medical Research
Institute, and BiochemistTy,' Faculty oJ Medicine',
Alexandria University, Egypt
ABSTRACT
Twenty-three patients diagnosed as established fascioliasis were
evrolled in the present study. Fasciolia cases were investigated for
serum iron, copper and their carrier proteins together with haemo-
globin and some blood indices. A significant reductior? in serum iron
was detected in the examined group. This reveals the occurrance of
iron deficiency anaemia in patients with chronic fascioliasis.
INTRODUCTION
Human fascioliasis is becoming a public health problem among
Egyptiars (Farag et ai., 1979, Osman, 1985 & 1991). In human infec-
tion mild to moderate and even severe anaemia has been reported
(Ashton and Beresford, 1974; Archimandrilis et al., 1976; Osman
1985 ard Acuna, and Braun, 1987), especally in heavy infections.
However, the mechanism an dthe type of anaemia in this parasitic
infection have not yet been fully investigated.

The present work aiaed to study blood indices together with the
serum' iron and rts carrier ?ransferrin and total iron binding capacity
together with serum copper and its carrier ceruloplasmin in patients
with chronic fascioliasis.
MATERIAL ard METHODS
Twenty-three patients suffering from chronic fascioiiasis, with
age group ranging from 15 - 35 years as well as 11 conirols of match&
age and sex were included in this work. Patients were diagnosed by
stool examination, using Kato-lratz technique (Katz et al., 1970). Then
the following investigations were done. (1) Conlplete blood @ctiiG
(Dacie and Lewis, 1969). (2) Serum iron (Trinder, 1956) and total
iron binding capacity (Ramsay, 1957) (3) Serum transferrin (Mancini
et al., 1965). (4) Serum copper (Meret and Hanliin, 1971) and
(5) Serum ieruloplasrnin (Mancini et al., 1965).
RESULTS
Resu!ts are presented in tables 1, 2 and 3

TABLE 2. Serum iron, total iron binding capacity, unsaturated iron biding capacity, percent saturation
and transferrin in the studied groups,
Iron TIBC UIBC 1% Transferrin
(&/dl) (,pg/dl) (flg/dl) saturation (Iu/ml)
I Control
- S.D. 106.1-24.93 332.2*51.09 232.1i43 95 31.54k6.36 33.60* 2.70
W
m Mean (+
0
Fasciola
Mean I& S.D. 77.9~21.26 358.3k74.06 282.0d=70.50 22.44k6.57 128.47*27.63

TABLE 3. Serum copper and ceruloplasmin of the studied groups,
--
Control
Mean :& S D, 123.00~23.56
,-
Copper Ceruloplasmin
(pg/dl) (W/ml)
Pasciola
Meail & S.D. 90.55t35.54 168.56*42.07
DISCUSSION
Tne presence of anaemia in human fascioliasis was reported in
peveral <strong>studies</strong> (Hardman et al., 1970; Perry et al., 1972 and Ragab &z
Farag 1978).
,In the present work serum iron, copper and their carrier proteins
&ither with haemoglobin and some blood indices were investigated
a:< ;. . - . ,
$'-patients with fascioliasis. Patients with chronic fascioliasis showed
@.* -:
Bi'significant reduction in their serum iron when compared to the
"'. ~
controls.
*u.&,~:, This reduced level was reflected on the patient's haemo-
E*
lo%in, haematocrit as well as mean corpuscular haemogl~bin con-
%$ration which were significantiy reduced in these patients. Total
"ai: 3erum iron binding capacity did not differ in the fascoliasii? group
! f t'he ~ control values. Transferrn, a Beta-1-globulin synthesized by
liver, which acts as transport protein for iron did not show any
Ehificant
.~ ~ change in the Fasciola group. This is expected because in
lished fascioliasis, the lesion is mainly in the biliary passages
neset al., 1977). Total iron binding capacity (TIBC) of the plasma
-usually .,... be equated with the transferrin concentration (Tietz, 1982).
@€&unsaturated iron binding capacity was calculated, it was found
Fie significantly increased in the Faseiola group, and its percent
CW"'.
Saturation was subsequently significantly reduced. Copper is an es.

sential trace element required for haemoglobin synthesis (Henry;
1979). The liver is the only site for synthesis of ceruloplasmin th/e
copper carrying protein (Walshe & Briggs, 1962). Ceruloplasmin, is
an a2-glycoprotein containing 6- 7 copper atoms per molecule (Titz,
1982).
In the present work, neither copper, nor ceruloplasmin showed
significant difference between fascioliasis and control groups. In
some parasitic infections, such as in advanced schistosomiasis, copper
concentration was found to be increased (Fayez et al., 1973; ~halifa
et a]., 1973 and Soliman et al., 1975) due to hepatic cell involvement.
Ceruloplasmin can be decreased in severe hepatocellular disease and
may be increased in chronic cholestasis (Henry, 1979).
Results of the present study indicate the occurrence of iron defi
ciency anaemia in cases suffering from fascioliasis. This may be due
to the haemorrhage which the young fluke cause during their mlgra.
tion within the liver (Facey and Marsde, 1960). Blood loss within the
bile was reported as a contributing factor (Borey 1969). Thus an
iron supplement is recommended for patients with fascioliasis to pre-
vent the occurrence of anaemia.
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