Relationship between Serum Ferritin Levels and Sarcopenia in Transfusion-Dependent Thalassemia Patient

Abstract

Introduction: Transfusion-dependent thalassemia (TDT) patients require regular blood transfusions for survival. One of the complications of repeated blood transfusions is iron overload, which occurs when iron accumulates in various organs and causes clinical complications. Recent studies have mentioned a correlation between increased ferritin and decreased skeletal muscle mass, but until now, no study has been conducted in thalassemia patients. We aim to evaluate the relationship between ferritin levels and sarcopenia in TDT patients. Methods: We included 81 TDT patients aged 18–65 years old at Dr. Soetomo Academic General Hospital, Surabaya, Indonesia, from April 1, 2024, to June 30, 2024. This was a single-center study and cross-sectional in design. Patients with a Karnofsky score ≤90, who had liver cirrhosis and a history of alcoholism, malignancy, acute infection, HIV, tuberculosis, hepatitis B, hepatitis C, diabetes mellitus, chronic kidney disease, obesity, and stroke were excluded. Results: Forty-five patients (55.6%) were sarcopenia and 36 patients (44.4%) were not sarcopenia. Age (P = 0.236), duration of thalassemia (P = 0.057), frequency of transfusion (P < 0.001), type of iron chelation (P < 0.001), and smoking habits (P = 0.029) had a significant association with ferritin serum levels. Protein diet (P = 0.03) and daily physical activity (P = 0.001) are significantly associated with sarcopenia. There was a significant difference between serum ferritin levels in the sarcopenia and nonsarcopenia groups (P < 0.001). Conclusions: Higher serum ferritin levels will increase the incidence of sarcopenia in TDT patients (adjusted odds ratio 1.001 [1.000–1.001]). A decrease in physical activity will increase the incidence of sarcopenia in TDT patients (P < 0.001).

Keywords

• ferritin serum
• human and disease
• iron overload
• sarcopenia
• thalassemia