Haematological abnormalities in transfusion dependent thalassemia patients: an observational study

Vishal A. Panjvani; Bhavin B. Padhariya; Vijay R. Bhalodia; Avani M. Kanzariya; Nayana R. Lakum

doi:10.18203/2349-3291.ijcp20253783

Authors

Vishal A. Panjvani Department of Pathology, GMERS Medical college and Hospital, Junagadh, Gujarat, India
Bhavin B. Padhariya Department of Pathology, GMERS Medical college and Hospital, Junagadh, Gujarat, India
Vijay R. Bhalodia Department of Pediatrics, GMERS Medical college and Hospital, Junagadh, Gujarat, India
Avani M. Kanzariya Department of Pathology, GMERS Medical college and Hospital, Junagadh, Gujarat, India
Nayana R. Lakum Department of Pathology, GMERS Medical college and Hospital, Junagadh, Gujarat, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20253783

Keywords:

Anemia, Hematological abnormalities, Red cell indices, Serum ferritin, Thalassemia, Transfusion-dependent thalassemia

Abstract

Background: Thalassemia is a common inherited hemoglobinopathy, with transfusion-dependent thalassemia (TDT) representing the most severe phenotype. Despite advances in transfusion and chelation therapy, patients remain at risk of hematological derangements arising from ineffective erythropoiesis, chronic anemia, and iron overload. Comprehensive evaluation of hematological indices in this population is essential for assessing transfusion adequacy and predicting complications. Objectives were to evaluate hematological abnormalities in transfusion-dependent thalassemia patients and to assess correlations between hematological indices and serum ferritin levels.

Methods: This hospital-based observational cross-sectional study was conducted in the departments of pediatrics and pathology, GMERS Medical College, Junagadh, over five months. A total of 43 children and adolescents with TDT, on regular transfusion for at least one year, were enrolled through universal sampling. Venous blood was collected prior to transfusion and analyzed using an automated hematology analyzer for hemoglobin (Hb), hematocrit (HCT), red blood cell (RBC) count, mean corpuscular indices (MCV, MCH, MCHC), red cell distribution width (RDW), total leukocyte count (TLC), and platelet count. Serum ferritin was measured using a fully automated biochemistry analyzer. Data were analyzed with SPSS v20; continuous variables were expressed as mean±SD, and correlations with ferritin were assessed by Pearson’s coefficient.

Results: Patients had persistent moderate anemia with mean hemoglobin 7.48±1.24 gm/dl and hematocrit 22.53±4.21%. RBC counts averaged 2.93±0.51 ×10⁶/µl, with microcytosis (MCV 76.83±5.32 fl), low MCH (24.91±2.90 pg), and relatively preserved MCHC (32.39±3.01 gm/dl). RDW was markedly raised (18.68±4.33%). TLC showed wide variability (11,418.60±8,351.91/µl), and thrombocytosis was frequent (platelets 445,667±210,270/µl). Serum ferritin was markedly elevated (4,236.32±3,248.98 ng/ml). Correlations between ferritin and Hb, HCT, MCH, and platelets were negligible or weak and statistically non-significant (p>0.05).

Conclusions: Transfusion-dependent thalassemia patients exhibited persistent anemia, microcytosis, hypochromia, anisocytosis, and frequent thrombocytosis despite regular transfusions. Serum ferritin levels, although elevated, showed poor correlation with hematological indices, underscoring their independent role as markers of iron overload rather than hematologic status. Continuous monitoring of complete blood counts alongside ferritin remains crucial for guiding management and preventing complications.

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References

Farmakis D, Porter J, Taher A, Domenica Cappellini M, Angastiniotis M, Eleftheriou A. 2021 Thalassaemia International Federation Guidelines for the Management of Transfusion-dependent Thalassemia. Hemasphere. 2022;6(8):e732. DOI: https://doi.org/10.1097/HS9.0000000000000732

Vasilopoulou M, Stafylidis C, Politou M. The thrombotic spectrum of B-thalassemia. Thrombos Update. 2022;7:100102. DOI: https://doi.org/10.1016/j.tru.2022.100102

Ribeil JA, Arlet JB, Dussiot M, Moura IC, Courtois G, Hermine O. Ineffective erythropoiesis in β-thalassemia. Sci World J. 2013;2013:394295. DOI: https://doi.org/10.1155/2013/394295

Bajwa H, Basit H. Thalassemia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.

Weng J, Brown CV, Rhee P, Salim A, Chan L, Demetriades D, et al. White blood cell and platelet counts can be used to differentiate between infection and the normal response after splenectomy for trauma: prospective validation. J Trauma. 2005;59(5):1076-80. DOI: https://doi.org/10.1097/01.ta.0000189001.00670.d2

Jesri A, Okonofua EC, Egan BM. Platelet and white blood cell counts are elevated in patients with the metabolic syndrome. J Clin Hypertens. 2005;7(12):705-11. DOI: https://doi.org/10.1111/j.1524-6175.2005.04809.x

Wang W, Knovich MA, Coffman LG, Torti FM, Torti SV. Serum ferritin: past, present and future. Biochim Biophys Acta. 2010;1800(8):760-9. DOI: https://doi.org/10.1016/j.bbagen.2010.03.011

Knovich MA, Storey JA, Coffman LG, Torti SV, Torti FM. Ferritin for the clinician. Blood Rev. 2009;23(3):95-104. DOI: https://doi.org/10.1016/j.blre.2008.08.001

Tilva KK, Jethwani D, Shah P, Dhruva GA. Comparative study of red blood cell parameters in different hemoglobinopathies diagnosed by HPLC at a tertiary care hospital, Rajkot, Gujarat. Med J Dr. DY Patil Univ. 2024;17(6):1196-200. DOI: https://doi.org/10.4103/mjdrdypu.mjdrdypu_929_23

Sanghavi J, Asati A. Profile of anemia with special reference to hemoglobinopathies in a tertiary care centre in Madhya Pradesh. Int J Pediatr Res. 2015;2:182-90. DOI: https://doi.org/10.17511/ijpr.2015.i04.20

Kumar S, Singh D, Garg A. An epidemiological study on the clinico-hematological profile of pediatric patients with congenital hemolytic anemia. Int J Contemp Pediatr. 2017;4:374-7. DOI: https://doi.org/10.18203/2349-3291.ijcp20170021

Langer AL. Beta-Thalassemia. 2000. In: Haldeman-Englert CR, Jewett T, Mulle JG, Gambello MJ, Russo RS, Murphy MM, et al. GeneReviews®. University of Washington, Seattle: Seattle (WA); 1993.

Piriyakhuntorn P, Tantiworawit A, Rattanathammethee T, Chai-Adisaksopha C, Rattarittamrong E, Norasetthada L. The role of red cell distribution width in the differential diagnosis of iron deficiency anemia and non-transfusiondependent thalassemia patients. Hematol Rep. 2018;10(3):7605. DOI: https://doi.org/10.4081/hr.2018.7605

Qurtom HA, Al-Saleh QA, Lubani MM, Hassanein A, Kaddoorah N, Qurtom MA, et al. The value of red cell distribution width in the diagnosis of anaemia in children. Eur J Pediatr. 1989;148(8):745-8. DOI: https://doi.org/10.1007/BF00443100

Khawaji MM, Hazzazi AA, Ageeli MH, Mawkili YH, Darbashi AH, Abo Kathiyah AMA, et al. Clinical and hematological features among β-thalassemia major patients in Jazan region: a hospital-based study. J Fam Med Prim Care. 2020;9(1):412-7. DOI: https://doi.org/10.4103/jfmpc.jfmpc_1007_19

Ammar SA, Elsayh KI, Zahran AM, Embaby M. Splenectomy for patients with β-thalassemia major: long-term outcomes. Egypt J Surg. 2014;33(4). DOI: https://doi.org/10.4103/1110-1121.147614

Aziz AN, Sayed SZ, Ismail DE, Mohamed ZH. Hematological parameters in beta thalassemia major children. Minia J Med Res. 2022;33(2):167-70. DOI: https://doi.org/10.21608/mjmr.2022.255684

Eldor A, Rachmilewitz EA. The hypercoagulable state in thalassemia. Blood. 2002;99(1):36-43. DOI: https://doi.org/10.1182/blood.V99.1.36

Karim MF, Ismail M, Hasan AM, Shekhar HU. Hematological and biochemical status of beta-thalassemia major patients in Bangladesh: a comparative analysis. Int J Hematol Oncol Stem Cell Res. 2016;10(1):7.