Correlation of Serum Ferritin Levels with Liver Function Tests and Anthropometric Measurements in Transfusion Dependent Beta-Thalassemia Major Children: A Cross Sectional Study

Abstract

Aim: To determine liver dysfunction and growth in transfusion-dependent beta-thalassemia children of age 2-16 years with iron overload state. Methods: Forty-one children aged 2-16 years with transfusion-dependent beta-thalassemia who were on chelation therapy with oral iron chelator deferasirox for at least 1 year were included in the study. Serum ferritin, growth assessment and liver function tests (LFT) were measured and correlated. Stunting was defined as low height for age (HFA). According to the World Health Organization (WHO), HFA between -2SD to -3SD was defined as moderate stunting and HFA less than -3SD as severe stunting. Spearmen correlation coefficient was used for finding out a correlation among different variables. Multiple linear regression was carried out to estimate the relationship between serum ferritin level, transfusion rate per year, age, sex and HFA status of thalassemia children. Results: Out of 41 children, 25 (60%) patients were in the age group of 5-10 years and the overall median age of the patients was 8 years. The overall median rate of blood transfusion was 12.3 per year and median ferritin levels were 3863 ng/ml (95% CI 2781-4860). There was a significant relationship between ferritin level and transfusion rate per year (p=0.048). The median aspartate aminotransferase (AST) was 51 IU/L (95% CI 43-66), alanine aminotransferase (ALT) 45 IU/L (95% CI 31-58). There was a significant relationship between ferritin level and AST, ALT levels (p<0.005) with correlation coefficient 0.31 and 0.55 respectively. AST and ALT levels were rising as the serum ferritin was increasing and after the level of 3000 ng/ml, there was a steep rise. Moderate stunting was seen in 9 (23%) patients with median ferritin level of 3452 ng/ml (95% CI 370–4992 ), severe stunting was present in 14 (34%) patients with median ferritin level of 4432 ng/ml (95% CI 2781 -4860 ) and normal height was seen in 18 (44%) cases with median ferritin level of 3992 ng/ml (95% CI 1904–4862) (p=0.4). Conclusion: High serum ferritin levels in beta-thalassemia are associated with hepatic dysfunction. Hence liver functions should be monitored frequently in patients with beta-thalassemia major. In our study, we found many children with stunting, but stunting is not affected by iron overload states.