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

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. This study aimed at investigating the prevalence of iron overload in NTDT patients and to evaluate the relationship between serum ferritin (SF) and liver iron concentration (LIC). 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* values. Total 56 NTDT patients of our study were in the age group of 8 to 12 years with the 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 (SF) levels were 556.93 ng/ml. There is a negative correlation between number of PRC transfusion, liver T2* values (r= -0.209, P=0.123) and cardiac T2* (r= -0.231, P=0.087).The T2* levels were inversely proportional to the dry weight of hepatic iron content. Hence, higher the number of PRC transfusion, lower were the T2* values and severe was the iron overload. We also concluded that liver overload was present in half of the participants (n=17, 53.13%) even in those who were either never transfused or received lesser than 10 units. Our study shows that there is a high prevalence of liver iron overload in NTDT patients. SF level is a non-reliable indicator for NTDT patients whereas T2* MRI values are a better indicator for assessment of iron overload in NTDT patients.