Association of transfusion burden with serum ferritin among patients with transfusion-dependent thalassemia: a cross-sectional study from Bangladesh

A. K. M. Shoyeb; Tareq Ahmed; M. Toufiq Hasan Khan

doi:10.18203/2320-6012.ijrms20263506

Authors

A. K. M. Shoyeb Department of Transfusion Medicine, Sirajganj Medical College, Sirajganj, Bangladesh
Tareq Ahmed Department of Transfusion Medicine, Northern International Medical College, Dhaka, Bangladesh
M. Toufiq Hasan Khan Department of Anatomy, Sirajganj Medical College, Sirajganj, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20263506

Keywords:

Bangladesh, Chelation adherence, Iron overload, Transfusion burden, Serum ferritin, Transfusion-dependent thalassemia

Abstract

Background: Regular red-cell transfusion is essential for patients with transfusion-dependent thalassemia (TDT) but causes progressive iron loading. Where MRI-based tissue iron assessment is not routinely available, serum ferritin remains a practical marker. This study evaluated the association between transfusion burden and serum ferritin in patients with TDT.

Methods: This cross-sectional study included 150 patients with TDT at Sirajganj Medical College Hospital, Bangladesh, from July 2025 to June 2026. Transfusion exposure, pre-transfusion hemoglobin, thalassemia phenotype, chelation adherence, splenectomy status, and serum ferritin were assessed. Associations were examined using Spearman correlation and multivariable linear and logistic regression.

Results: Mean age was 17.06±6.87 years; 60.7% were male. Median annual transfusion burden was 144.08 ml/kg/year (IQR 126.95–161.41) and median ferritin was 1965.00 ng/mL (IQR 1329.28–2723.51); 31.3% had ferritin ≥2500 ng/mL. Annual transfusion burden correlated positively with ferritin (coefficient=0.231, p=0.004). After adjustment, each additional 10 ml/kg/year was associated with 5.9% higher ferritin (B=0.057, 95% CI 0.030–0.083; p<0.001) and 27% higher odds of ferritin ≥2500 ng/mL (aOR 1.27, 95% CI 1.08–1.50; p=0.004). Poor chelation adherence was strongly associated with ferritin ≥2500 ng/mL (aOR 6.92, 95% CI 2.84–16.85; p<0.001).

Conclusions: Greater transfusion burden and poor chelation adherence were independently associated with higher serum ferritin. Tracking transfusion volume, serial ferritin, and chelation adherence may improve iron-overload monitoring in resource-constrained TDT care.

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