Liver Enzyme to Hemoglobin Ratios and Indices in Blood Transfusion-Dependent Pediatric Βeta Thalassemia Major Patients Treated With Deferasirox or Deferoxamine

Background: Beta thalassemia is correlated with liver dysfunction resulting from repeated blood transfusions and treatment with iron chelating agents (ICAs). Objective: To investigate the indices derived from liver enzymes and hemoglobin (Hb) as a laboratory tool for assessing liver dysfunction and to clarify its relationship to the use of ICAs.

Patients and procedures: This retrospective cross-sectional descriptive analysis was performed on the Beta thalassemia major patients who were presented at the Sulaimani Thalassemia Center, Kurdistan Region, Iraq. Patients were classified into three groups according to their treatment: blood transfusion only (Group I), blood transfusion combined with deferasirox (Group II), and blood transfusion combined with deferoxamine (Group III). The primary outcome is ratios and indices derived from liver enzymes and Hb, and the secondary outcome is the hematological indices.

Results: Alanine or aspartate to Hb ratios and indices were increased significantly in Group II compared with Groups I or III. Alanine aminotransferase (ALT) to Hb index at a cut-off value of 9.0 was found to be a sensitive (85–95%) for liver dysfunction and specific (85%) for liver dysfunction in Group II. There were no significant changes in the hematological indices, while ALT and AST levels were significantly higher in Group II.

Conclusion: An important indicator of hemolytic anemia and liver dysfunction in thalassemia patients on deferasirox is the ALT-Hb index, which can be used to monitor the patients.

Keywords: Hepatotoxicity, alanine aminotransferase, aspartate aminotransferase, iron chelation therapy, biomarker indices.