Assessment of Serum Ferritin, Thyroid Profile and Calcium Homeostasis in Beta-Thalassemia Major Patients

Background 𝛽-thalassemia major (𝛽-TM) is the most severe form of 𝛽-thalassemia. Serum ferritin is considered as a surrogate marker of iron overload and hemosiderosis. Iron deposition is the main cause of damage to endocrine glands in patients with 𝛽-TM. Furthermore, frequent blood transfusion (BT) may lead to altered calcium and phosphate homeostasis in patients. Increased ferritin levels and hepatic iron overload may be associated with vitamin D deficiency and altered bone metabolism. The aim of the study was to analyze serum ferritin, thyroid profile, vitamin D, serum calcium, and serum phosphate levels in 𝛽-TM patients undergoing BT. Further, the study aimed to determine the association of serum ferritin with thyroid profile, hematological parameters and calcium homeostasis in 𝛽-TM patients. Materials & methods 𝛽-TM patients (N = 35) aged 6 months to 168 months were recruited. Laboratory investigations, CBC, serum ferritin, vitamin D, serum calcium, serum phosphate, and thyroid profile, were performed. Statistical analysis Statistical analysis was performed by SPSS version 21 (IBM Corp., Armonk, NY, USA). Data obtained from biochemical parameters - serum ferritin, vitamin D, serum calcium, serum phosphate, and thyroid profile from 𝛽-TM patients - were subjected to descriptive analysis. Normal distribution of variables was analyzed using the Shapiro-Wilk test. Data were not normally distributed; hence, nonparametric tests were used for statistical analysis. Bivariate correlation between two variables was analyzed by Spearman-rank's correlation test. Result In our study, the mean serum ferritin value was 2328.6 ng/ml (159.60-5958.80), and 15 (42.8%) patients had severe hyperferritinemia. Female 𝛽-TM patients had severe vitamin D deficiency, and the frequency of hypocalcemia was higher in males and 4 (11%) patients showed deranged values of phosphate. 𝛽-TM patients had a deranged thyroid profile, 10 (28.5%) of the patients had low thyroxine (T4), whereas elevated TSH was noted in 15 (42.8%) patients. Conclusion Our study showed that hematological parameters such as WBC and platelet count exhibited association with serum vitamin D, T3, calcium and phosphate levels, but a large number of sample size is required to validate the findings. Routine monitoring of endocrine function or early detection of endocrine complications is needed to improve their quality of life. Our study generates preliminary data; further studies, multicentric studies or studies on larger sample sizes, are required.