Iron Overload in Thalassemia Major: An Observational and Cross-sectional Study

Abstract

Objective

Managing iron overload in thalassemia requires a reliable assessment of excess iron load and organ iron distribution. Trends in serum ferritin have been most commonly used as an inexpensive guide to evaluate the body iron stores. Liver biopsy remains the gold standard for estimating iron overload. Here we have evaluated the liver iron in thalassemia major patients and compared it to the serum ferritin.

Method

In the present cross-sectional study, 55 patients of thalassemia major were enrolled. Serum ferritin estimate was compared to the iron status determined by histopathological examination of the liver biopsy specimens.

Result

Very high serum ferritin was present in these young thalassemics. Almost 90% of biopsy samples had grade 3–4 iron deposition. A good correlation was found between serum ferritin values and hemosiderosis of the liver. Significantly higher grades of liver fibrosis were observed in these Indian Thalassemics.

Conclusion

Serum ferritin can be used as a serum marker of somatic iron stores. However, it cannot replace invasive and non-invasive liver iron assessments for a more accurate estimation. Direct examination of liver specimens also allows us to grade fibrosis, which was present in almost 90% of the biopsy samples. Awareness needs to be created regarding the high iron overload and its consequences on the long-term survival of patients. Meanwhile, we need to optimize the chelation therapy and impress upon the need for regular monitoring of iron overload for better outcomes.