Iron overload in non-transfusion-dependent thalassemia- experience at a tertiary care center in India

Abstract

Background

Non-transfusion-dependent thalassemia (NTDT) patients can be at risk of iron overload, despite not being transfused frequently. Iron overload is a major risk factor that increases morbidity and mortality in non-transfusion dependent thalassemia patients.

Aim

This study looked at the prevalence of iron overload in NTDT patients and evaluated the relationship between serum ferritin and calculated liver iron concentration (LIC) based on T2∗MRI.

Methods

We conducted an observational and retrospective study in a tertiary care centre of the metropolitan country of India from January 2019 to November 2020. We evaluated the prevalence of iron overload in NTDT patients, the relationship between number of PRC transfusions, serum ferritin levels, hepatic and cardiac iron as measured by validated R2 magnetic resonance imaging with T2∗ MRI values.

Results & discussion

Total of 56 NTDT patients were 8–12 years old with a mean age of 9.38 years. Majority of our study participants were beta thalassemia intermedia 45 (80.4 %) followed by HbE/β thalassemia 7(12.5 %) and 2 each (3.6 %) as HbH disease and Delta Beta Thalassemia. Magnetic resonance Imaging (T2∗ MRI) was done in 56 patients. Of these 35(62.5 %) had hepatic overload and 9 (16.1 %)) had cardiac overload. The mean serum ferritin level was 556.93 ng/ml. There was a negative correlation between the number of PRC transfusion, and liver T2∗ MRI values (r = −0.209, P = 0.123) as well as cardiac T2∗MRI T2∗ (r = −0.231, P = 0.087). Since T2∗ MRI values are inversely proportional to iron overload, the higher the number of PRC transfusions, the lower were the T2∗ values. We found that liver iron overload was present in half of the participants (n = 17, 53.13 %) even those who were never transfused or received less than 10 units.

Conclusion

Our study shows that there is a high prevalence of liver iron overload in NTDT patients. Serum Ferritin is an unreliable indicator, whereas T2∗ MRI values are better for assessing iron overload in NTDT patients.