Impact of gender and chelation on the ferritin–liver function test relationship in transfusion-dependent β-thalassaemia

OBJECTIVES: Transfusion-dependent β-thalassaemia (TDT) requires lifelong blood transfusions, resulting in progressive iron overload and liver injury. Serum ferritin is a practical surrogate for iron burden, while liver function tests (LFTs) may reflect hepatic damage. However, the influence of gender and the chelation regimen on the ferritin-LFT relationship remains underexplored. This study evaluated these associations in a large Iraqi TDT cohort. METHODS: A retrospective cross-sectional study was conducted on 323 patients with TDT at the Center of Hereditary Blood Diseases, Karbala, Iraq. Data on demographics, ferritin, LFTs, transfusion history and chelation regimen were collected. Mann-Whitney U test, Fisher's exact test, Spearman's correlation and multiple linear regression were used to explore predictors of ferritin, including interaction terms. Receiver operating characteristic (ROC) analysis assessed aspartate aminotransferase (AST) and alanine aminotransferase (ALT) cut-offs for predicting ferritin >2500 ng/mL. RESULTS: Median ferritin was 2214 ng/mL. AST (ρ=0.581) and ALT (ρ=0.516) showed strong positive correlations with ferritin (p