Hepatic iron overload in transfusion-dependent paediatric thalassemia (TDT) patients: association of magnetic resonance imaging with serum ferritin level

Abstract Background Chronic blood transfusions cause iron overload in patients with transfusion-dependent thalassemia (TDT). Iron accumulation in vital organs must be monitored and controlled to avoid long-term consequences. Aim To assess the prevalence and severity of hepatic iron overload in TDT patients using MRI and determine the association with serum ferritin levels, transfusion history, and clinical parameters. Methods This cross-sectional observational study included 80 TDT patients aged ≥ 3 years who had received > 8 transfusions annually for at least 1 year. Detailed clinical history, duration and number of transfusions, and chelation therapy were documented. Blood ferritin and abdominal MRI were used to assess iron overload in the liver. Statistical analysis was performed using SPSS, with a significance level of p < 0.05. Results Patients in our study had a mean age of 6.14 ± 3.43 years, with 62.5% being male. The mean serum ferritin level was 1665.58 ± 498.68 ng/ml, with 70% above 1500 ng/ml. MRI detected hepatic iron overload in 91.2% of thalassaemic patients, of which 46.2% were of severe type. The severity of hepatic iron overload was significantly associated with serum ferritin levels ( p = < 0.001), > 120 transfusions ( p = < 0.001), > 36 months of transfusion history ( p = < 0.001) and hepatomegaly ( p = 0.002). Chelation treatment for more than 5 years reduced the severity. On univariate regression analysis, we found age (OR 1.44, 95% CI 1.16–1.94), mild hepatomegaly (OR 3.75, 95% CI 1.09–15.45), moderate hepatomegaly (OR 6.00, 95% CI 1.63–29.32), wasting (OR 2.61, 95% CI 0.88–8.91), number of transfusions/year (OR 1.86, 95% CI 1.47–2.65) and duration of chelation therapy (OR 2.76, 95% CI 1.71–5.37) were the risk factors for the development of moderate to severe iron load on MRI. On multivariate analysis, the number of transfusions/year (OR 3.13, 95% CI 1.52–14.17), moderate hepatomegaly (OR 18.03, 95% CI 0.25–7656.54) and duration of chelation therapy (OR 5.68, 95% CI 0.72–242.34) were risk factors for moderate to severe iron load on MRI. Conclusion TDT patients often have excess iron, which can be detected by blood ferritin level and MRI. Early detection, monitoring, and chelation therapy are crucial to avoid problems.