Assessment of growth retardation among transfusion-dependent Thalassemia patients in Peshawar, Pakistan

OBJECTIVE: To investigate the relationship between repeated blood transfusions and growth retardation in children with transfusion-dependent Thalassemia in Peshawar, Pakistan. METHODS: This cross-sectional study was conducted on transfusion-dependent thalassemia patients receiving treatment at the Fatimid Foundation, Peshawar Pakistan, between February and August 2022. Participants were categorized by age (<1 year, 1–2 years, and >2 years) to assess and measure growth patterns over six months. RESULTS: Out of 93 children with thalassemia major, 55 (59.1%) males and 38 (40.9%) females. Mean age of the participants was 10.86 ± 5.72 years, and mean age at their first transfusion was 8.13 ± 5.78 months. Mean body mass index was 16.38 ± 1.82 kg/m². Short stature was observed in 49 patients (52.7%), of whom 57.1% (n=28) were male and 42.9% (n=21) were female. Serum ferritin levels were significantly elevated in patients with short stature, with 57.1% (n=28/49) having ferritin levels >4001 μg/L compared to 40.9% (n=18/44) with normal stature. Only 3.2% of patients had normal ferritin levels. The ROC analysis identified a ferritin cut-off of 1636 μg/L for predicting short stature (sensitivity 86%, specificity 68%). Growth assessment showed that 71% of the children were <50th percentile. Hemoglobin levels and early transfusion age were also associated with short stature, highlighting the impact of iron overload on growth. CONCLUSION: This study highlights the detrimental effects of thalassemia on growth in transfusion-dependent children, primarily from iron overload and high ferritin levels, emphasizing the importance of better management strategies to prevent complications and promote healthy development.