Relation of ferritin levels to pulmonary function in patients with thalassemia major and the acute effects of transfusion
Abstract: We studied 36 patients (17 males and 19 females) with thalassemia major by performing pulmonary function testing (PFT), arterial blood gas analysis (ABG), as well as determining the serum ferritin level. In addition, 19 of these patients were transfused with two units of packed cells, and a repeat ABG and PFT were performed. Twenty‐three patients had normal PFTs, eleven patients (30.6%) showed a restrictive pattern (significant decrease in both TLC and DLCO), and only two patients (5.6%) showed an obstructive pattern. A significant negative correlation was found between serum ferritin and restrictive parameters, DLCO and TLC (p=0.01 and p=0.03, respectively). This correlation was even stronger after transfusion. Controlling for age, ferritin was still negatively correlated with DLCO (p=0.04), but no longer with TLC. There was no correlation between age and DLCO or age and TLC; however, there was a statistically significant negative correlation between age and FVC (p=0.003). Analysis of patients who were transfused revealed a significant decrease in forced vital capacity (89±4% vs. 74±5% of predicted; p‐value<0.001) and in maximum midexpiratory flow rate (79±4% vs. 67±5% of predicted; p‐value=0.004). For patients older than 15 yr of age, there was a statistically significant decrease in FEV1/FVC (84±2 vs. 83±2%; p‐value=0.04). The ABGs showed no significant change post‐ transfusion. In this study, PFT findings in thalassemia major were restrictive and correlated with serum ferritin level. Transfusion had an acute effect on the obstructive parameters of PFT.
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