Endocrine impact of transfusion therapy: parathyroid status in pediatric thalassemia major

Background: Thalassemia major, a severe form of inherited anemia, requires lifelong blood transfusions to manage the condition and sustain hemoglobin levels. However, these repeated transfusions often lead to iron overload, which can deposit in various organs, including endocrine glands and disrupt normal hormone production. One such affected gland is the parathyroid, responsible for regulating calcium and phosphate balance through parathyroid hormone (PTH) secretion. This study aimed to assess the parathyroid status in children with thalassemia major. Methods: This case-control analytical study design was considered to assess the parathyroid status in children with thalassemia major. The study was carried out at the Department of Pediatric Hematology and Oncology, Dhaka Medical College Hospital, Dhaka, from July 2012 to June 2013. A total of 40 children with thalassemia major (termed as case) and another 32 normal children (termed as control) were included in the study. Data were analyzed using SPSS (Statistical Package for Social Sciences) version 16. Results: The study found that children with thalassemia major had significantly lower parathyroid hormone (PTH) levels and higher phosphate levels compared to healthy controls, though calcium levels were similar between groups. Thalassemia patients, primarily receiving blood from professional donors, underwent transfusions for an average of six years, with limited use of chelation therapy (15%). Hypoparathyroidism was significantly more common in thalassemia patients (10%) compared to controls, with 25% also showing hyperphosphatemia. No significant differences were observed in age or sex distribution between the groups. Conclusions: It can be concluded children with thalassemia possess significantly low serum PTH and high phosphate levels. The serum calcium level does not alter significantly compared to healthy children of similar age and sex. The findings call attention to the critical need for early intervention, regular endocrine screening and diligent chelation therapy in managing thalassemia major.