Correlation Between Pulmonary Functions and Iron Overload in Transfusion Dependent Thalassemia Patients Registered in Chughtai Thalassemia Center: A Cross-Sectional Study

Abstract

Objective: To find correlation between pulmonary function abnormalities with raised serum ferritin levels and Pattern of pulmonary dysfunction in patients with Transfusion Dependent Thalassemia.

Methodology: A Cross-sectional study was Conducted at Thalassemia Centre, Chughtai Institute of pathology, Lahore, Pakistan from March 2025 to September 2025. Fifty patients aged between 7–38 years with transfusion-dependent ?-thalassemia who had received ?20 blood transfusions or had serum ferritin levels greater 1000 ng/mL were enrolled. Patients with known pulmonary disease, acute infection, or inflammatory conditions were excluded. Serum ferritin levels were measured to assess iron overload, and C-reactive protein was used to exclude inflammation. Pulmonary function was evaluated using spirometry, measuring forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/FVC ratio. Patterns and severity of pulmonary dysfunction were correlated with serum ferritin levels.

Results: Out of 50 patients, 52% exhibited a restrictive pattern of pulmonary dysfunction, 8% had an obstructive pattern, and 40% had normal pulmonary function. Mean serum ferritin levels increased progressively with the severity of restrictive lung disease (normal: 1888 ng/mL; mild: 3685 ng/mL; moderate: 5289 ng/mL; severe: 9206 ng/mL; p = 0.003). Patients with obstructive patterns also demonstrated significantly elevated ferritin levels. A significant correlation was observed between higher serum ferritin levels and impaired pulmonary function.

Conclusion: Restrictive pulmonary dysfunction is the most common respiratory abnormality in patients with transfusion-dependent thalassemia and is significantly associated with iron overload. Regular pulmonary function monitoring and strict adherence to iron chelation therapy are recommended to reduce iron-related pulmonary complications.