Association of Iron Overload with Hepatic Function Abnormalities in Transfusion Dependent Beta-Thalassemia Major Children- Insights from a Thalassemia Center in Karachi

Abstract

Objective: To determine iron overload induced liver function abnormalities in transfusion dependent beta thalassemia major patients and to analyze relationship between serum ferritin levels with liver enzymes.

Methodology: This cross-sectional study was conducted in Baqai Medical University Karachi and Muhammadi Thalassemia Center Karachi from December 2021 to May 2022. Total 100 transfusion dependent beta-thalassemia major patients were included. Lab investigations for serum ferritin and liver function tests were performed on Roche Cobas c111 and e411 analyzers.

Results: Serum ferritin, Bilirubin, ALT, and ALP levels from blood samples of 100 patients with ages ranging from 2 to 16 years were analysed. Females constituted 51 % of the samples. Ferritin levels were not significantly different between genders (p= 0.1429). Patients were divided into two groups according to ferritin levels (<2500ng/mL) and (>2500ng/mL). Median(IQR) for ALT level of group 1 and 2 was 47.0 (34.0–67.0) and 164.0 (89.0–200.0) respectively, whereas median(IQR) ALP level for each group was 125.0 (92.5–161.5) and 200.0 (172.0–224.0) respectively. There was a significant, strong positive correlation of rise in ALT(r=0.675) and ALP(r=0.677) as ferritin levels rose (>2500ng/mL). Bilirubin levels were high in patients with ferritin levels (<2500ng/mL). There was a weak and non-significant correlation of rise in bilirubin levels, with iron overload (>2500ng/mL).

Conclusion: Elevated serum ferritin levels indicate iron overload induced derangement of the liver functions in transfusion dependent beta-thalassemia major children. There is a strong positive association between increased serum ferritin levels and increased liver enzymes levels.