Association of Copper, Zinc, Copper-to-zinc ratio and Disease Severity Scores in Sickle Cell Anemia: An Observational Analytical Study.

Objective: The purpose of the study was to assess the amount of serum copper, zinc, and copper-to-zinc ratio in sickle cell anemia patients and healthy subjects and to relate the parameters with an objective disease severity score. Further, to see the correlation between copper and zinc levels with fetal hemoglobin level in sickle cell anemia (SCA) subjects in both stable state and during the crisis.

Materials and methods: Copper and zinc levels in serum of 100 SCA and 100 healthy subjects were measured using commercially available kits. The copper-to-zinc ratio was then obtained by dividing the copper and zinc levels. High-performance liquid chromatography (HPLC) was used to determine the fetal hemoglobin level of every participant. The data were compared between SCA subjects in a stable state, crisis state, and control subjects using the Student's t-test, and the variables were linked with disease severity levels using the Pearson's correlation coefficient.

Results: The levels of copper and the ratio of copper-to-zinc were notably elevated in SCA patients compared to controls, whereas zinc levels were lower in the SCA patients. Zinc level was associated negatively (r = -0.350; p < 0.001), while the ratio of copper to zinc was associated positively (r = 0.246; p = 0.014) with objective disease severity scores.

Conclusion: Copper levels were elevated, while zinc levels were reduced in sickle cell anemia patients, and the ratio of copper-zinc in these patients may predict the severity of the disease.