Liver Enzymes Abnormalities and their Correlation with Serum Ferritin in Beta Thalassemia Major Patients with Multiple Blood Transfusions: A Cross-Sectional Study

Objective: To determine liver enzymes (Alanine Transaminase: ALT and Aspartate Transaminase: AST) abnormalities in β-thalassemia major patients with multiple blood transfusions and to correlate these enzymes with serum ferritin. Methods: This cross-sectional study was conducted at the Pathology Department of The Children’s Hospital and Institute of Child Health, Multan, from December 2024 to February 2025. Children aged 2–14 years with β-thalassemia major, receiving regular transfusions, on chelation therapy, and with serum ferritin >1000 ng/mL were included. Demographic data, transfusion frequency, chelation compliance, and laboratory results were recorded using a structured proforma. Liver enzyme abnormalities were defined as ALT >35 U/L and AST >45 U/L. Patients were categorized into three groups based on serum ferritin levels: 1000–2000 ng/mL, 2001–3000 ng/mL, and >3000 ng/mL to assess their correlation with liver enzyme abnormalities. Results: A total of 107 patients, the median age was 6.0 years (4.0-9.0). There were 70 (65.4%) males and 37 (34.6%) females. Abnormal liver enzymes were observed in 94 patients (87.9%). Liver enzyme abnormality was significantly associated with higher serum ferritin levels (p-value = 0.005) and poor compliance to chelation therapy (p-value <0.001). A significant increase in liver enzymes (ALT and AST) was observed across ferritin categories (both p-values <0.001). Correlation analysis showed a positive correlation between serum ferritin and liver enzymes (for ALT ρ = 0.663, p-value <0.001, for AST ρ = 0.662, p-value <0.001)