Serum ferritin levels and endocrinopathy in medically treated patients with β thalassemia major

Abstract

The association between iron overload indices and pathology of the heart and liver in transfusion-dependent patients with β thalassemia major (TM) has been extensively studied. Nonetheless, data on endocrine disease remains limited. This was a cross-sectional study of 382 TM patients treated with regular transfusions and desferrioxamine at the Thalassemia Center in Dubai, UAE. Retrieved data included demographics, splenectomy status, steady-state serum ferritin levels, and the presence of endocrinopathies (diabetes mellitus, hypothyroidism, hypoparathyroidism, and hypogonadism). Multivariate logistic regression analyses were used to determine which variables were independently associated with the occurrence of each endocrinopathy. The mean age of patients was 15.4 ± 7.6 years, with an equal sex distribution. The mean serum ferritin level was 2597.2 ± 1976.8 μg/l. The frequencies of specific endocrinopathies were diabetes mellitus (10.5%), hypothyroidism (6.3%), hypoparathyroidism (10.5%), and hypogonadism (25.9%). On multivariate logistic regression analysis, patients with a serum ferritin level >2,500 μg/l, but not >1,000-2,500 μg/l, were 3.53 times (95% CI 1.09-11.40) more likely to have diabetes mellitus, 3.25 times (95% CI 1.07-10.90) more likely to have hypothyroidism, 3.27 times (95% CI 1.27-8.39) more likely to have hypoparathyroidism, and 2.75 times (95% CI 1.38-5.49) more likely to have hypogonadism compared to patients with a serum ferritin level ≤1,000 μg/l. However, splenectomized patients with serum ferritin levels ≤2,500 μg/l had comparably high rates of all endocrinopathies as patients with serum ferritin levels >2,500 μg/l. Endocrinopathy is common in TM patients treated with desferrioxamine therapy, especially in patients with serum ferritin levels >2,500 μg/l or those splenectomized.

Comparative study of serum ferritin and vitamin D in thalassemia patients with healthy controls

“…7 Serum ferritin levels in medically treated patients with β thalassemia major was studied by Belhoul KM et al The association between iron overload indices and pathology of the heart and liver in transfusion-dependent patients with β thalassemia major has been extensively studied. 8 The mean value of serum ferritin was increased and these results were in close collaboration with the results obtained by Mishra AK et al These levels reflect inadequate chelation and vulnerability to develop iron overload related complications. There is an urgent need to rationalize the chelation therapy and to create awareness about the consequences of iron overload in the patients.…”

Diabetes Mellitus and Impaired Glucose Tolerance in β-Thalassaemia Major Patients with Secondary Haemchromatosis: Frequency and their Associations from a Developing Country

“…A cross-sectional study of 382 BTM patients treated with regular transfusions and desferrioxamine, demonstrated that patients with serum ferritin level >2,500 ng/ml were 3.53 times (95% CI 1.09 11.40) more likely to have DM [36]. Some studies have also reported that ferritin levels of patients with DM were not significantly different from those patients who had no DM [30,34].…”

Serum Hepcidin Level and Human Factors Engineering (HFE) C282Y Mutation in Egyptian Children with Beta-Thalassemia

“…Multiple transfusions can lead to the accumulation of excessive iron in the body which needs to be corrected using chelating agents to remove excess iron by excretion [15].…”

“…Serum ferritin levels of greater than 2500 μg/l are known to have high rates of iron overload-related complications [15]. But individuals with Cys282Tyr homozygosity might present with abnormal iron tests with or without clinical symptoms and with or without proving evidence of iron overload [27].…”