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Association of Methylenetetrahydrofolate Reductase (MTHFR C677T) Gene Polymorphism and Hemoglobin Level, Platelets Count, Platelets Indices Among Sudanese Sickle Cell Disease Patients

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01 September 2026

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01 September 2026

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Abstract
Background: One potential risk factor for vaso-occlusive issues in sickle cell anemia (SCA) is the C677T polymorphism of the methylene tetrahydrofolate reductase gene. This study examined the relationship between hemoglobin levels, platelet counts, and platelet indices and the methylenetetrahydrofolate reductase (MTHFR C677T) gene variant in Sudanese patients with sickle cell disease (SCD). Methods: This case-control study involved 48 patients with HbSS and 48 healthy controls. Complete blood count (CBC) was measured using an automated blood counter analyzer, and allele-specific PCR was performed for the amplification of the MTHFR gene. SPSS version 20 was used to analyze the data. Results: Participants ranged in age from1-15 years and were evenly split by gender. Hemoglobin levels, MPV, PCT, PDW, and P-LCR were significantly different between patients with Sickle Cell Disease (SCD) and the control group (p < 0.05). However, there was no significant change in platelet count (p = 0.919). In the SCA group, 68.7% of the MTHFR C677T genotypes were wild-type (CC), 18.8% were homozygous mutants (TT), and 12.5% were heterozygous (CT). 14.6% were CT, 6.2% were TT, and 79.2% were CC among the controls. Patients with SCA had an odds ratio of 0.286 for MTHFR mutation, which was not statistically significant (p = 0.11). Nonetheless, SCA demonstrated a significant correlation through allele frequency analysis (p = 0.000; OR = 0.470; 95% CI: 0.223–0.990). Conclusion: SCD is associated with increased platelet indices and decreased hemoglobin levels. Although the MTHFR C677T polymorphism is more common in SCD patients, it did not show a statistically significant correlation with the disease.
Keywords: 
SCD
;  
platelet count
;  
MPV
;  
PCT
;  
PDW
;  
P‐LCR
;  
MTHFR C677T
Subject: 
Biology and Life Sciences  -   Other

Introduction

The most common genotype of sickle cell anemia (SCA), an autosomal recessive hematological disorder caused by a mutation in the hemoglobin gene, is homozygous hemoglobin S (HbSS), and common heterozygous conditions include hemoglobin sickle beta zero thalassemia, hemoglobin sickle beta plus thalassemia, and hemoglobin sickle cell disease (HbSC) [1]. The disease is prevalent among people in Sub-Saharan Africa, South Asia, the Middle East, and the Mediterranean [2]. The highest prevalence occurs in western Sudan, especially among the Misseriya and Albagara tribes; in Darfur, HbS allele frequencies can reach 30.4% [3,4,5], Leukocytes and thrombocytes are both equally affected b SCD, which primarily affects red blood cells [6]. Platelet indices, including MPV, PCT, PDW, and P-LCR, are implicated in vascular problems; recent research has focused on their significance as potential predictive biomarkers [7,8]. Despite the growing evidence, the clinical significance of these biomarkers is still under investigation. Furthermore, genetic variations, specifically in the MTHFR gene (C677T and A1298C), have been linked to an increased risk of vaso-occlusive events in patients with SCA; mutations in the C677T gene have been documented more frequently [9,10].
This study aimed to investigate the relationship between hemoglobin levels, platelet counts, and platelet indices associated with the methylene tetrahydrofolate reductase (MTHFR C677T) gene variant in Sudanese individuals with SCD.

Materials and Techniques

A total of ninety-six children, aged 1 to 15 years, were enrolled in this case-control study at Gaafar Ibnauf Hospital in Khartoum, Sudan, from May to December 2022. Among these, 48 patients were diagnosed with sickle cell disease (cases), while the other 48 functioned as healthy controls. After a blood samples were collected in an ethylenediaminetetraacetic acid (EDTA) vacutainer, a Sysmex XP 300 automated blood counter was used to quantify platelet count, estimate hemoglobin levels, and analyze platelet indices. Genomic DNA was isolated from whole blood with the G-DEXTM genomic DNA extraction kit (INTRON Biotechnology, Korea), DNA was kept at -20 °C until used. To detect MTHFR C677T polymorphisms in DNA samples, prior to beginning all reagents were allowed to defrost at room temperature, gently mixed by tube inversion and spin down, and 20 µL reaction mixes were prepared (Template DNA 2μl, Primer A 10pmol 1μl, Primer B10pmol 1μl, Distilled water 16μl). Gelectrophoresis was used to evaluate the amplicon sizes before digesting the amplified MTHFR gene into its different fragments.

Ethical Consideration

Ethical approval was obtained from the scientific committee of college of medical laboratory science, Sudan University of Science and Technology, ethical committee (No. RC-CLS-03-04-2022) prior to commencement of the study, informed consent was obtained from each participant.

Statistical Analysis

IBM SPSS version 20 was used to analyze the data, which were presented in tables and figures. The mean and standard deviation of the frequencies were calculated. A chi-square test was conducted to detect the relationship between qualitative variables. An independent t-test was used to compare two groups based on qualitative and quantitative variables. For every statistical test used in this investigation, a P.value of < 0.05 was deemed significant. The Chi-square test and odds ratio (OR) with 95% CI were used to assess the frequency distribution of the genotypes and alleles among the study groups.

Results

This case-control study involved ninety-six participants: 48 were patients with sickle cell disease, while the other 48 were healthy volunteers serving as controls. The participants’ ages ranged from 1 to 15 years old, with mean ages of 8.1±3.2 and 9.5±3.1 years for the case and control groups, respectively. The age groups were distributed as follows: 1–5 years 12 (25%), 6–10 years 23 (48%), and 11–15 years 13 (27%), for the case group, and 1–5 years 8 (16%), 6–10 years 20 (48%), and 11–15 years 20 (27%) as in Table 1.
According to Table 2, a comparison of the study population’s hematological parameters revealed statistically significant differences with the mean of Hb, MPV, PCT, PDW, and P-LCR (p. values = 0.000, 0.00, 0.008, 0.000, 0.000, 0.002), and an insignificant difference with Plts (P. values = 0.919).

Genetic Analysis

The prevalence of the MTHFR C677T gene polymorphism was determined through PCR amplifications. The prevalence of MTHFR C677T gene mutations in SCD patients was as follows: 33 patients, or 68.7% of the total, were wild type (CC), 9 patients, or 18.8%, were homozygous (TT), and 6 patients, or 12.5%, were heterozygous (CT). Three (6.2%) of the controls were homozygous (TT) for the MTHFR C677T gene mutation, seven (14.6%) were heterozygous (CT), and 38 (70.2%) were wild type (CC). There was no statistically significant difference between the MTHFR C677T and C677T mutations (OR = 0.286, 95% CI: 0.52-1567, P=0.11). The frequency of this allele was significantly linked to SCD (P.V =0.00) OR 0.470 (95% CI: 0.223 - 0.990) Table 3.
Table 4 showed that the PLCR is the only parameter that exhibits a significant change in mean (p=0.039), although the genotypes of MTHFR (C677T) in the case and control exhibited insignificant association with the mean of Hb, PLTs, MPV, PCT, and PDW (P. values = 0.171, 0.990, 0.203, 0.852, and 0.121, correspondingly).
The study indicated that the correlation between the study variables and gender was statistically insignificant for all parameters, except MTHFR C677T, which was significant (P.value = 0.000), and the association between gender, age, and all variables was statistically insignificant, Table 5.

Discussion

This case-control hospital-based study included 96 participants, 48 of whom were SCD cases and 48 of whom were healthy volunteers (controls). Males made up 24 (50%) of the case group and females 24 (50%) of the control group. The case group’s mean age was 8.1 ± 3.2 years, while the control group’s was 9.5 ± 3.1 years. The age range of participants was from 1 to 15 years, with the majority (48%) falling between 6 and 10 years old. This was consistent with a study conducted in Uganda, which found that the majority of participants were between 6 and 10 years old [11]. The mean Hb was 8.4±1.7 in the case and 13.0±1.8 in the control, which indicated a significant decrease (P. value = 0.000). This result was consistent with a study conducted in Iraq in 2022 that found a significant reduction in Hb levels among SCA patients [12]. Additionally, a study conducted in North Darfur State by Sudanese researchers found that individuals with SCA consistently had a low average hemoglobin (Hb) level of 5. These findings are also in harmony with those of studies by Aliu et al. [13], Feugray et al. [14], and Jabbar et al. [15]. The current study’s findings showed that the level of PLT in SCA patients was insignificantly higher than that in the control group (263.2±109.1) when compared to the healthy group (261.4±68.0), with a P. value of 0.919. This finding of higher PLTs in SCD than in the control group contradicts earlier research that found a significant increase in PLT in sickle cell anemia patients compared with the control group [12,13,16], and another study conducted in Ghana by Antwi-Boasiak et al. in 2018 revealed a significant increase in platelet count in SCD patients when compared to their healthy counterparts [17]. The type of medicines used, as well as genetic and environmental factors, may be may be due to this observed discrepancy. MPV mean was significantly higher (P. value =0.008) when comparing study groups, which was consistent with findings from previous studies that demonstrated a rise in MPV levels [18,19,20], despite this finding is contradicted by Al-Khalidi and Ghazzay, whose results showed a drop in MPV levels [12]. and in lined with Adawi et al.’s study, which found that PDW was significantly higher in SCA as compared with controls (p<0.05) [20] , these findings suggest that the increased platelet distribution width may serve as a potential biomarker for diagnosing and monitoring SCD. The current study’s results showed a highly significant increase in mean PDW in SCD cases compared to the control group (P. value = 0.000). This finding was similar to Khalidi and Ghazzay’s study in Iraq, which found that PDW was significantly higher in SCD than in the control, with a p.value of 0.000 [12]. PCT mean was significantly higher in this study when compared to the control group (P. value = 0.000). This result is consistent with Antwi-Boasiako et al. [17], Akwiwu et al. [19], and Adawi et al. [20], who reported that PCT was significantly higher in SCD patients compared to control subject.
P-LCR mean was significantly different in case compared to control (20.6 ± 3.2 vs. 17.5 ± 6.0, P.value = 0.002), which is consistent with Musa et al. (2023), who found that P-LCR was the only platelet parameter that significantly differed between bone pain crises and steady states in patients with sickle cell anemia [21].
The frequency of MTHFR C677T genotypes for CC, CT, and TT in cases was 33(68.7) %, 6(12.5) %, and 9(18.8) %, respectively, whereas in the control group, the odds ratio (OR) was 0.286 (95%CI: 0.52-1.567), but the difference was statistically insignificant (P.value = 0.11). This result is similar to a study done in Eastern Saudi Arabia in 2004 that found that patients (8/87) had a higher prevalence of the MTHFR 677 T/T genotype than controls (4/105), with P. value = 0.217; OR = 2.56) indicating that the MTHFR gene mutation is insignificant to SCA [22], the result of this study in contrast to a study conducted in Pernambuco, Brazil, which found that 677 CT and TT genotypes indicated a significant risk of vascular complications (p=0.015), the polymorphism MTHFR C677T appeared to be potentially predictive of the development of certain vascular complications in SCA patients within this population [23], additionally, a study conducted in 2013 by Nishank, et al. found that patients with SCD had a significantly higher prevalence of mutant variants of the MTHFR gene than normal/control individuals and polymorphisms in MTHFR C677T may increase the risk of vascular problems in SCD patients [24], also disagree with A meta-analysis of 11 studies in various populations was chosen, comprising 559 patients without VC and 614 SCD patients with VC, this meta-analysis in a fixed effect model demonstrated that mutant genotypes (CT+TT vs. CC) of the polymorphism were associated with an increased risk of vascular complications (OR=1.81, 95% CI=1.37-2.40, P<0.001)[25] . Also, Patel et al. 2021 study revealed a significant correlation between the severity index score of children with sickle cell disease and MTHFR polymorphisms C677T and A1298C. The study also found that the frequency of CC, CT, and TT genotypes of C677T was (71.9%, 26.1%, and 2.0%), respectively, in the study population [26]. In this study, hemoglobin and MTHFR C677T homozygous and heterozygous variants showed an insignificant correlation with hemoglobin (P. value = 0.171). This was in contrast to Patel et al. 2021 study [26], which found an insignificant correlation between hemoglobin and C677T genotypes (P. value = 0.49), and Giammarco et al. found a significant correlation between patients with MTHFR C677T homozygous and heterozygous variant and lower hemoglobin values (P. value = 0.01) [27].
PLTs in this study revealed a statistically insignificant correlation between patients carrying these variants (P. value = 0.990), which disagrees with Giammarco et al. who discovered a trend that did not reach statistical significance between patients carrying MTHFR C677T homozygous and heterozygous variants and lower platelet count with P. value = 0.006 [27]. This study found that the genotypes of the MTHFR C677T mutation were statically significant when correlated with gender (0.000), this result not match with a cross-sectional study conducted among SCA patients attending the Hematology Clinic of the Lagos State University Teaching Hospital by Adelekan, et al., report that MTHFR C677T mutation not statistically significant when correlated with gender of the participants [28], and to Patel et al. found that the association between the MTHFR C677T mutation and gender was statically insignificant (P.value = 0.91)[26]. According to this study, there was no significant correlation between age and the MTHFR C677T mutation. This finding is consistent with the results of Patel et al. and Adelekan et al., who reported that the association between C677T genotypes and age was also statistically insignificant [26,28].

Conclusion

This study concludes that hemoglobin, platelets, and platelet indices (MPV, PCT, PDW, and PLCR) exhibited substantial differences among patients with sickle cell disease. The MTHFR C677T polymorphism showed no statistical significance among patients with sickle cell disease, indicating that MTHFR C677T polymorphism has a minimal impact within the study group.

Funding

This study received no funding from any corporation, non-profit organization, or governmental entity.

Acknowledgments

The authors would like to thank the Laboratory personnel at Gaafar Ibnauf Hospital in Khartoum, Sudan.

Authors’ contributions

MMA conceptualized, visualized, designed, and interpreted the results, coordinated the laboratory quality control, supervised the study, and wrote the draft manuscript. TMH conducted the study, selected methodology and data analysis. HHA wrote the draft manuscript and checked the methodology and data analysis. TSA, AMA, EAN, ABA, AAA, and AA reviewed the methodology, conducted data analysis, and performed editing. They also critically approved the manuscript for exceptional intellectual content. All authors read and approved the final manuscript.

Declaration of Conflicting Interest

The authors stated that there is no conflict of interest in this work.

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Table 1. Demographic data of case and control groups.
Table 1. Demographic data of case and control groups.
Socio-Demographic Characteristics Case frequency (%)
(n = 48) 		Control frequency (%)
(n = 48)
Gender Male 24(50%) 24(50%)
Female 24(50%) 24(50%)
Total 48(100%) 48(100%)
Age group/ years 1-5 years 12(25%) 8(16%)
6-10 years 23(48%) 20(42%)
11-15 years 13(27%) 20(42%)
Total 100(100%) 100(100%)
Mean age/ years (8.1 ± 3.2) (9.5 ± 3.1)
Age range/ years 1-15 1-15
Table 2. Comparison of hematological parameters among study groups.
Table 2. Comparison of hematological parameters among study groups.
Parameters Cases group (Mean ± SD) Control group (Mean ± SD) P.value
Hemoglobin(g/dl) (8.4 ± 1.7) (13.0 ± 1.8) 0.000
PLTs (X109/L) (263.2± 109.1) (261.4± 68.0) 0.919
MPV(fl) (8.6± 1.2) (8.0± 0.9) 0.008
PCT% (0.3 ± 0.1) (0.2 ± 0.04) 0.000
PDW(fl) (13.8 ± 2.5) (11.1 ± 2.6) 0.000
P- LCR% (20.6 ± 3.2) (17.5 ± 6.0) 0.003
Table 3. MTHFR (C677T) gene Polymorphisms among the study groups.
Table 3. MTHFR (C677T) gene Polymorphisms among the study groups.
MTHRFR (C677T)
 SCD cases
(n=48) 		Control
(n=48) 		P. value OR (95%CI)
Genotypes CC 33(68.7%) 38(79.2%)
0.11
0.286(0.52-1.567)
CT 6 (12.5%) 7(14.6%)
TT 9 (18.8%) 3(6.2%)
Alleles C 72(75%) 83(87%)
0.00
0.470(0.223-0.990)
T 24(25%) 13(13%)
Table 4. Association between MTHFR genotypes (C677T) and Hematological Parameters.
Table 4. Association between MTHFR genotypes (C677T) and Hematological Parameters.
Parameters(mean ± STD ) CC CT TT P.value
Hb 10.7± 2.7 11.9 ± 2.8443 9.8 ± 3.7 0.171
Plts count 264.4 ± 90.9 262.0 ± 97.4 260.97 ± 89.4 0.990
MPV 8.2 ± 1.2 8.1 ± 0.7 8.8 ± 0.85 0.203
PCT 0.2 ± 0.1 0.2 ± 0.1 0.3 ± 0.1 0.852
PDW 12.2±3.1 12.2±2.3 13.9±1.2 0.121
P-LCR 18.6±5.0 17.9±3.8 22.2±5.1 0.039
Table 5. Association of MTHFR (C677T) polymorphism and hematological measures with gender and age.
Table 5. Association of MTHFR (C677T) polymorphism and hematological measures with gender and age.
Variables
(Mean± TD) 		Genders P. value Age group (years) P. value
Male Female 1-5 6-10 11-15
Hb(g/dl) 10.8±2.7 10.6±3.1 0.785 10.5±2.5 10.7±3.3 11.0±2.62 0.824
PLTs 264.4±91 262.9±91 0.934 296.7±105.5 245.3±84.4 267.6±85.0 0.104
MPV(fl) 8.2±1.3 8.3±0.9 0.764 8.3± 0.8 8.3±1.3 8.2±1.0 0.848
PCT% 0.2± 0.1 0.2±0.1 0.879 0.3±0.1 0.2±0.1 0.2±0.1 0.144
PDW(fl) 12.5±3.4 12.4±2.2 0.896 12.8±2.5 12.8±3.1 11.9±2.7 0.348
P- LCR% 18.7±5.1 19.4±4.9 0.491 19.3±4.5 19.8±5.5 17.8±4.51 0.212
MTHFR (C677T) 1.0 ±0.0 1.8±0.8 0.000 1.3±0.7 1.40±0.7 1.42±0.7 0.937
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