Ultrasonographically Detected Gallbladder Disease in Transfusion-Dependent Beta-Thalassemia: Correlation with Iron Overload and Transfusion Burden

Abstract

Objective: To determine the prevalence of USG-detected gallbladder disease in patients suffering from transfusion dependant thalassemia.

Methodology: In this descriptive, cross-sectional study 106 consecutive patients, of beta thalassaemia major, were studied at Pakistan Railways hospital over a period of six months from October 2024 to February 2025.  Abdominal ultrasonography was performed to evaluate the underlying gallbladder disease.

Results: Out of 106 patients with transfusion dependant thalassemia 51 (48%) were males and 55 (51.9%) were females. 17 (16.04%) patients were less than 10 years, 53 (50.00%) were between 10 and 20 years and 36 (33.96%) were older than 20 years.  38 (36.85%) patients had gall bladder disease detected on ultrasonography. 4 (3.77%) patients already had cholecystectomy for symptomatic gall stones, 16 (15.1%) had gall stones and 18 (16.98%) had sludge in gall bladder. Amongst the patients with gall bladder disease 6 (15.79%) were less than 10 years, 16 (42.1%) were between 10 and 20 years, 14 (36.84%) between 20 and 30 years and 2 (5.26%) were above 30 years of age. 28 (73.68%) patients with gallbladder disease had received more than two transfusion every month, while 10 (26.31%) had received two or less transfusions per month with p-value> 0.02. Among the patients with gallbladder disease, 33 (86.8%) had serum ferritin levels above 2500 ng/ml, while 5 (14.3%) had levels below this threshold, p-value<0.01.

Conclusion; Gall bladder disease is a common complication in transfusion dependant thalassemics in Pakistan, therefore, ultra-sonographic evaluation should be considered early and continued at regular intervals to avoid serious complications. High serum ferritin and increased transfusions frequency had a  significant association with  cholelithiasis and gall bladder sludge