Frequency of Heart Failure in Thalassemia Patients on Chelation Therapy

Abstract

Background: Beta-thalassemia major is a transfusion-dependent hemoglobin disorder in which repeated blood transfusions can lead to progressive iron overload and cardiac injury. Although chelation therapy reduces iron-related complications, heart failure may still occur because of poor chelation adherence, persistent anemia, high serum ferritin levels, and delayed cardiac surveillance.

Objective: To determine the frequency of heart failure among beta-thalassemia major patients receiving chelation therapy and to assess its association with demographic, laboratory, transfusion-related, and clinical factors.

Methods: This cross-sectional study was conducted in the Department of Pediatric Medicine, DHQ Hospital, Dera Ghazi Khan, over six months. A total of 100 children aged 5–15 years with confirmed beta-thalassemia major receiving oral deferasirox chelation therapy for at least one year were enrolled through non-probability consecutive sampling. Demographic characteristics, disease duration, transfusion pattern, chelation regularity, hemoglobin level, serum ferritin, chest X-ray findings, and echocardiographic parameters were recorded. Heart failure was diagnosed on the basis of predefined clinical findings and echocardiographic evidence of reduced ejection fraction. Data were analyzed using SPSS version 20.0, and associations were assessed using the chi-square test, with p≤0.05 considered statistically significant.

Results: The mean age of the patients was 9.8 ± 2.9 years, and 56.0% were male. The mean disease duration was 6.7 ± 2.7 years. Heart failure was identified in 20 patients, giving an overall frequency of 20.0%. The mean serum ferritin level was 3778 ± 1675 ng/mL, while the mean pre-transfusion hemoglobin level was 8.6 ± 1.1 g/dL. Among patients with heart failure, hepatomegaly was the most common clinical finding, observed in 90.0%, followed by respiratory distress in 75.0%, basal crepitations in 65.0%, pitting edema in 55.0%, and raised jugular venous pressure in 40.0%. The mean ejection fraction was lower in patients with heart failure than in those without heart failure. Heart failure was significantly associated with shorter transfusion interval, lower hemoglobin category, higher serum ferritin category, poor chelation regularity, and cardiomegaly on chest X-ray.

Conclusion: Heart failure was present in one-fifth of beta-thalassemia major children receiving deferasirox chelation therapy. High serum ferritin, low pre-transfusion hemoglobin, frequent transfusion requirement, poor chelation regularity, and cardiomegaly were significantly associated with heart failure, highlighting the need for optimized transfusion support, strict chelation adherence, regular ferritin monitoring, and routine cardiac evaluation in thalassemia care.