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

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.