Correlation of respiratory function tests with serum ferritin level in children with transfusion-dependent beta-thalassemia

Objective: To determine the frequency of asymptomatic respiratory dysfunction and assess the correlation between respiratory function tests and serum ferritin levels in children with transfusion-dependent beta-thalassemia major. Material and Methods: A cross-sectional study was conducted at the Pediatric Medicine Department, Allama Iqbal Teaching Hospital, DG Khan, Pakistan (Jan–June 2025). We enrolled 136 children (5–15 years) with beta-thalassemia major confirmed by Hb electrophoresis and regular transfusion history. Exclusion criteria included congenital heart disease, pre-existing pulmonary disorders, active infections, or chest deformities. Serum ferritin levels were measured from venous blood samples analyzed at a centralized laboratory. Pulmonary function tests (FVC, FEV1, FEV1/FVC, PEFR, PEF 25–75%) were performed using standardized spirometry. Pearson correlation (r) assessed relationships between ferritin and respiratory parameters. Results: The cohort (mean age 10.02 ± 2.97 years; 56.6% male) exhibited a high prevalence of asymptomatic respiratory dysfunction (61.8%): restrictive pattern (56.6%), obstructive (5.1%), and normal function (38.2%). Mean serum ferritin was 3420.93 ± 1354.90 µg/L. Inverse correlations were observed between serum ferritin and FVC (r = −0.570, p < 0.001) and FEV1 (r = −0.321, p < 0.001). No significant correlations existed with FEV1/FVC, PEFR, or PEF 25–75% (p > 0.05). Conclusion: Asymptomatic restrictive respiratory dysfunction is prevalent in pediatric beta-thalassemia major. Elevated serum ferritin levels significantly correlate with reduced FVC and FEV1, indicating iron overload contributes to pulmonary impairment. Keywords: Beta-thalassemia; Ferritins; Respiratory Function Tests; Iron Overload; Child; Cross-Sectional Studies; Pakistan