The Impact of Chelation Therapy on Hepcidin, Ferritin, and Fertility Hormones in Female with Beta Thalassemia Major

Abstract

Background: Chelation therapy plays a crucial role in the management of beta-thalassemia major, a genetic disorder characterized by defective hemoglobin production, resulting in chronic anaemia and iron overload due to frequent blood transfusions. Over time, excess iron accumulates in vital organs, causing significant damage, which is why chelation therapy, aimed at removing excess iron, is a standard treatment approach. However, this therapy's impact extends beyond iron regulation, influencing various physiological processes, including the regulation of hepcidin, ferritin, and fertility hormones. Hepcidin is a key regulator of iron homeostasis, while ferritin serves as an iron storage protein that reflects the body’s iron levels. Understanding the complex interplay between chelation therapy and these biomarkers is critical for improving the management of beta-thalassemia major and mitigating potential long-term complications OBJECTIVES: This study aims to evaluate the impact of chelation therapy on iron regulation and fertility hormones in females with beta thalassemia major. Methods: A cross-sectional case–control study was conducted over 12 months from January to June 2024 involving 180 women (90 healthy controls and 90 patients) aged 16-40 years. Patients were randomly selected according to the specific inclusion and exclusion criteria. The serum levels of hepcidin hormone, ferritin, and fertility hormones were measured by Enzyme-Linked Immunosorbent Assay. SPSS Program was used to code, enter, and process the gathered data. RESULTS: Serum hepcidin levels in patients with good compliance did not differ significantly from those with poor compliance while Ferritin levels were significantly lower in good compliance patients (769.16±176.36) vs. poor compliance (868.62±140.81), p=0.005. LH and prolactin showed non-significant increases in good compliance (1.40±0.77, 2.55±1.11) vs. poor compliance (1.39±0.86, 2.28±1.08). FSH and estradiol levels were significantly higher in good compliance patients (2.51±1.20, 11.65±0.95) compared to poor compliance (1.87±0.95, 11.20±1.04), p<0.05. CONCLUSIONS: Patients with better compliance to iron chelation had higher hepcidin, lower ferritin, and improved FSH and E2 levels, emphasizing the importance of adherence to therapy.

Keywords

• hepcidin
• fertility hormone
• ferritin
• thalassemia
• chelation therapy