Iron Overload and Its Impact on Liver Function and Lipid Profiles in Transfusion-Dependent β-Thalassemia Patients in Sana'a City.

Abstract

Background: β-thalassemia major (βTM) is a severe genetic blood disorder that necessitates regular blood transfusions, which often lead to iron overload and associated complications, including liver dysfunction and dyslipidemia.

Objective: To investigate the relationship between iron overload, liver function abnormalities, and lipid profile disturbances in transfusion-dependent β-thalassemia patients in Sana'a, Yemen.

Methods: A cross-sectional study was conducted among 53 participants recruited from the Yemeni Association for Thalassemia Patients and Genetic Blood Disorders in Sana'a City. Participants were divided into four groups: healthy controls, β-thalassemia patients receiving regular blood transfusions with or without iron chelation therapy (ICT), and nontrans fused thalassemia patients. Clinical data were collected using structured questionnaires, and Biochemical and haematological parameters, including serum ferritin, serum iron, GPT (ALT), bilirubin, triglycerides (TG), HDL, LDL, cholesterol, hemoglobin (Hb), and white blood cell (WBC) counts, were measured. The data were analyzed using SPSS Version 20. Normality was assessed with the ShapiroWilk test. Parametric tests, including independent sample ttests and ANOVA, were used to compare continuous variables. Categorical data were analyzed with the chi-square test. A Bonferroni correction was applied to adjust for multiple comparisons.

Results: Serum ferritin levels above 1,000 ng/mL were considered elevated, and iron levels were significantly higher in transfusion-dependent patients, particularly those receiving blood for >5 years or >250 mL per transfusion. Group II (patients receiving blood transfusions with ICT) and Group III (patients receiving blood transfusions without ICT) showed significantly elevated ferritin and serum iron levels compared to Group IV (non-transfused patients). Patients with high ferritin levels also exhibited significantly elevated GPT and direct bilirubin, indicating liver damage, with the highest levels observed in Group II and Group III. Furthermore, these patients had higher triglycerides and lower HDL, LDL, and total cholesterol, consistent with dyslipidemia. Haematological parameters showed reduced hemoglobin and RBCs, and increased WBCs among patients with iron overload.

Conclusion: Iron overload is strongly associated with liver dysfunction and dyslipidemia in transfusion-dependent β-thalassemia patients. The findings suggest that iron chelation therapy helps reduce the impact of iron overload on liver function and lipid metabolism. Routine monitoring of ferritin, liver enzymes, and lipid profiles is essential for managing these complications. Effective iron chelation therapy is critical, and improving access to ICT and establishing better follow-up strategies are needed to mitigate the long-term consequences of iron overload.