Correlation between serum ferritin level and liver function tests in thalassemic patients receiving multiple blood transfusions

Mahmood Asif, Zahid Manzoor, Muhammad Shehzad Farooq, Amama Kanwal, Uzma Shaheen, Shaukat Hussain Munawar, Imran Ahmad Khan, Abdul Aziz


Background:Multiple blood transfusions are the mainstay of thalassemic patients in order to combat the severe anemia. These frequent blood transfusions result in the excessive iron deposition, leading to multiple injuries to a variety of organs in the body. In response to these injuries, the levels of various enzymes are disturbed. The whole phenomena usually involve the interrelation of one parameter with some other. The present study aimed to estimate the levels of serum ferritin and hepatic enzymes and to find out any possible correlation between them in thalassemic patients receiving multiple blood transfusions.  

Methods:A total number of 90 thalassemic patients of both sexes ranging from 10-15 years, receiving multiple blood transfusions were included in the present study. Blood samples from all the patients were withdrawn and analyzed for the values of serum ferritin, hemoglobin and hepatic enzymes (serum alanine transaminase, serum aspartate transaminase, serum alkaline phosphatase). Pearson correlation coefficient was applied to observe correlation between serum ferritin level and hepatic enzymes. A P value of ≤0.05 was considered statistically significant.

Results:The overall values of serum ferritin, and hepatic enzymes (serum Alanine Transaminase, serum Aspartate Transaminase, serum Alkaline Phosphatase) were remarkably increased than their normal values. However, hemoglobin level was considerably decreased in thalassemic patients. A weak positive insignificant correlation was observed between serum ferritin with hepatic enzymes and hemoglobin in thalassemic patients.

Conclusion:Multiple blood transfusions cause iron overload in the body, which in turn, lead to increased serum ferritin levels in thalassemic patients. High levels of hepatic enzymes are somewhat correlated to serum ferritin concentration. However, the exact reason of elevated levels is still unclear. Further detailed studies should be conducted in order to identify the exact mechanism behind this and to search for the promising correlations of various parameters in thalassemic patients receiving multiple blood transfusions.



Thalassemia, Blood transfusions, Serum ferritin, Hepatic enzymes, Correlation

Full Text:



Sharada AS. Thalassemia and related hemoglobinopathies. Ind J Pediatr. 2005;72:319-24.

Cappellini MD, Cohen A, Eleftheriou A, Piga A, Porter J, Taher A. TIF guidelines for clinical management of thalassemia. In: Cappellini MD, Cohen A, Eleftheriou A, Piga A, Porter J, Taher A, eds. Guideline. 2nd ed. Nicosia Cyprus: Thalassemia International Federation Nicosia Cyprus; 2008: 21-35.

Galanello R, Origa R. Beta-thalassemia. Orphanet J Rare Dis. 2010;5:11-8.

Weatherall DJ. The thalassemias. In: Stamatoyannopoulos G, Nienhuis AW, Majerus PH, Varmus H, eds. The Molecular Basis of Blood Diseases. 2nd ed. Philadelphia: W.B. Saunders; 1994: 157-205.

Satwani H, Raza J, Alam M, Kidwai A. Endocrinal complications in thalassemias: frequency and association with ferritin levels. Pak Pediatr J. 2005;29:113-9.

Flint J, Harding RM, Boyce AJ, Clegg JB. The population genetics of the hemoglobinopathies. Baillieres Clin Hematol. 1993;6:215-62.

Leung TN, Lau TK, Chung TK. Thalassemia screening in pregnancy. Curr Opinion Obstet Gynecol. 2005;17(2):129-34.

Cao A, Galanello R. Beta- thalassemia. Genetics Med. 2010;12:61-76.

Neufeld EJ. Update on iron chelators in thalassemia. Hematology the education program of the american society of hematology. In: Neufeld EJ, eds. Education Program. US: American Society of Hematology; 2010: 451-455.

Malik SA, Syed S, Ahmed N. Frequency of hypothyroidism in patients of beta-thalassaemia. J Pak Med Assoc. 2010;60:17-20.

Borgna-Pignatti C, Cappellini MD, De Stefano P, Del GC, Vecchio D, Forni GL, et al. Survival and complications in thalassemia. Ann N Y Acad Sci. 2005;1054:40-7.

Angulo IL, Covas DT, Carneiro AA, Baffa O, Junior JE, Vilel G. Determination of iron-overload in thalassemia by hepatic MRI and ferritin. Rev Bras Hematol Hemoter. 2008;30:449-52.

Tori FM, Tori SV. Regulation of ferritin genes and proteins. Blood. 2002;99:3505-16.

Prabhu R, Prabhu V, Prabhu RS. Iron overload in beta-thalassemia. A review. J Biosci Tech. 2009;1:20-31.

Oliveri NF, Brittenham GM. Iron-chelating therapy and the treatment of thalassemia. Blood. 1997;89:739-61.

Schumann G, Klauke R. New IFCC reference procedures for the determination of catalytic activity concentrations of five enzymes in serum: preliminary upper reference limits obtained in hospitalized subjects. Clin Chim Acta. 2003;327:69-79.

Schlebusch H, Rick W, Lang H, Knedel M. Standard in the activities of clinically important enzymes. Dtsch Med Wonchenschr. 1974;99:765-6.

Baig SM, Azhar A, Hassan H, Baig JM, Aslam M, Amin-ud-Din M. Prenatal diagnosis of β-thalassemia in Southern Punjab, Pakistan. Prenat Diag. 2006;26:903-5.

Mariani R, Trombini P, Pozzi M, Piperno A. Iron metabolism in thalassemia and sickle cell disease. Mediterr J Hematol Infect Dis. 2009;1:e2009006.

Hershko C. Pathogenesis and management of iron toxicity in thalassemia. Ann N Y Acad Sci. 2010;1202:1-9.

Stefano R. Ineffective erythropoiesis and thalassemias. Curr Opinion Hematol. 2009;16:187-94.

Knovich MA, Storey JA, Coffman LG, Torti SV. Ferritin for the clinicians. Blood Rev. 2009;23:95-104.

Davis BA, Sullivan C, Jarritt PH, Porter JB. Value of sequential monitoring of left ventricular ejection fraction in the management of thalassemia major. Blood. 2004;104:263-9.

Ong CK, Lim SL, Tan WC, Ong EE, Goh AS. Endocrine complications in transfusion dependant thalassemics in Penang hospital. Med J Malaysia. 2008;63:109-12.

Porter JB. Practical management of iron overload. Br J Haematol. 2001;115:239-52.

Dufour DR, Lott JA, Nolte FS, Gretch DR, Koff RS, Seeff LB. Diagnosis and monitoring of hepatic injury: recommendations for use of laboratory tests in screening, diagnosis, and monitoring. Clin Chem. 2000;46:2050-68.

Afzal S, Ahmad M, Roshan A, Mubarik A, Qureshi H, Saleem N. Morphological study of liver biopsy in thalassemia major. J Pak Med Assoc. 2004;54:415.

Hanif M, Raza J, Qureshi H, Isani Z. Etiology of chronic liver disease in children. J Pak Med Assoc. 2004;54:119-22.

De Sanctis V, Eleftheriou A, Malaventura C. Prevalence of endocrine complications and short stature in patients with thalassemia major: a multicentre study by the Thalassemia International Federation (TIF). Pediatr Endocrinol Rev. 2004;2(Suppl 2):249-55.

Cheema AN, Dilshad AK. Detection of hepatotoxicity by non-transferrin bound iron in beta-thalassemia major. Intern J Pathol. 2011;9:10-4.

Tolman KG, Rej R. Liver functions. In: Burtis CA, Ashwood ER, eds. Tietz Textbook of Clinical Chemistry. 3rd ed. Philadelphia, PA: W.B. Saunders Company; 1999: 1125-1177.

Wiwanitkit V. High serum alkaline phosphatase levels, a study in 181 Thai adult hospitalized patients. BMC Fam Pract. 2001;2:2.

Anderson GJ. Non-transferrin-bound iron and cellular toxicity. J Gastroenterol Hepatol. 1999;14:105-8.