International Journal of Medical and All Body Health Research  |  e-ISSN: 2582-8940  |  Double-Blind Peer Review  |  Open Access  |  CC BY-NC-SA 4.0

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     2026:7/4

International Journal of Medical and All Body Health Research

e-ISSN: 2582-8940 | Open Access

Cardiac Complications in Iraqi Children with Beta-Thalassemia Major: Association with Serum Ferritin and Chelation Adequacy

Dafer Mahammad Hussein Etaij, Karrar Abdil Aziz Ali Beg, Alaa Jumaah Manji Nasrawi

Department of Pediatrics, College of Medicine, Jabir Ibn Hayyan University for Medical and Pharmaceutical Sciences, Najaf, Iraq; Department of Pediatrics, College of Medicine, University of Kufa, Najaf, Iraq

Article Information

Volume / Issue7 / 2 (April-June 2026)
Pages216-222
AccessOpen Access

Publication Timeline

  • Received26 March 2026
  • Accepted24 April 2026
  • Published

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Abstract

Background: Beta thalassemia major (BTM), an inherited hemoglobinopathy, is characterized by absent or severely reduced β-globin chain synthesis, resulting in transfusion-dependent anemia that begins early in life. Cardiac complications, primarily iron-overload cardiomyopathy and congestive heart failure, remain the most common cause of mortality in these patients despite several decades of advances in supportive care.
Objective: To investigate the cardiac function in Iraqi children with BTM using ECG and Echocardiography, to determine whether abnormal findings of these tests are related to inadequate chelation therapy (assessed by urine drug levels) and body iron overload (estimated by serum ferritin), and to assess the correlation between CXR parameters versus echocardiographic measurements.
Methods: A cross-sectional study of 49 patients with beta-thalassemia major (BTM) disorder followed up at the outpatient clinic of AL-Zahraa Teaching Hospital, Al-Najaf, Iraq, from June to November 2025, comprising 29 males and 20 females aged between 10 months and 17 years.) ECG, transthoracic echocardiography, and CXR were performed in all the patients. We defined chelation adequacy as deferoxamine use≥ 4 days/week (optimal) or <4 days/week (suboptimal). Statistical analysis: Chi-square and Student's t-tests were applied using SPSS v20 (Significance level P < 0.05).
Results: Among the 42 chelated patients, ECG abnormalities were paradoxically more frequent in those receiving optimal chelation (62.5%) than in those on suboptimal regimens (30.8%; P = 0.04). Cardiomegaly on CXR followed a similar pattern (25% vs. 7.7%, P > 0.05), as did pericardial thickening on echocardiography (50% vs. 42.3%). In contrast, serum ferritin level showed a clear dose-response relationship with cardiac burden: patients with ferritin ≥1000 ng/mL had significantly higher rates of cardiomegaly (29.4% vs. 3.1%, P < 0.05) and ECG abnormalities (70.6% vs. 18.8%, P < 0.001) than those with lower ferritin. Six patients (12%) had clinically overt congestive heart failure.
Conclusions: Cardiac involvement is substantial in this Iraqi BTM cohort, and serum ferritin is a strong correlate of cardiac abnormalities. The paradoxically higher prevalence of ECG changes and cardiomegaly among optimally chelated patients most likely reflects confounding by indication — cardiac abnormalities prompting intensification of an already-interrupted regimen — rather than any direct effect of treatment. These findings underscore the need for early, uninterrupted chelation and regular cardiac surveillance in this population.
 

Keywords

Beta Thalassemia MajorCardiac DysfunctionChelation Therapy

References

  1. Kliegman RM, Behrman RE, Jenson HB, Stanton BF, DeBaun MR, Vichinsky E. Nelson textbook of pediatrics. 18th ed. Philadelphia: Saunders; 2007. p. 2033. [Google Scholar][Crossref]
  2. Weatherall DJ, Clegg JB. The thalassaemia syndromes. 4th ed. Oxford: Blackwell Science; 2001. [Google Scholar][Crossref]
  3. Thein SL. Is it dominantly inherited beta thalassaemia or just a beta-chain variant that is highly unstable? Br J Haematol. 1999;107(1):12-21. [Google Scholar][Crossref]
  4. Fessas P, Stamatoyannopoulos G, Karaklis A. Study of hemoglobinopathy resembling thalassemia in the heterozygous state. Blood. 1962;19:1-11. [Google Scholar][Crossref]
  5. Shamshirsaz AA, Bekheirnia MR, Kamgar M, et al. Metabolic and endocrinologic complications in beta-thalassemia major: a multicenter study in Tehran. Pediatr Endocrinol Rev. 2003;1 Suppl 2. [Google Scholar][Crossref]
  6. Nathan DG, Stossel TP, Gunn RB, et al. Influence of hemoglobin precipitation on erythrocyte metabolism in alpha and beta thalassemia. J Clin Invest. 1969;48(1):33-41. [Google Scholar][Crossref]
  7. Olivieri NF, Nathan DG, MacMillan JH, Wayne AS, Liu PP, McGee A, et al. Survival in medically treated patients with homozygous beta-thalassemia. N Engl J Med. 1994;331(9):574-8. [Google Scholar][Crossref]
  8. Kremastinos DT, Tsiapras DP, Tsetsos GA, Rentoukas EI, Vretou HP, Toutouzas PK. Left ventricular diastolic Doppler characteristics in beta-thalassemia major. Circulation. 1993;88(3):1127-35. [Google Scholar][Crossref]
  9. Liu P, Olivieri N. Iron overload cardiomyopathies: new insights into an old disease. Cardiovasc Drugs Ther. 1994;8(1):101-10. [Google Scholar][Crossref]
  10. Buja LM, Roberts WC. Iron in the heart: etiology and clinical significance. Am J Med. 1971;51(2):209-20. [Google Scholar][Crossref]
  11. Mancuso L, Panzarella G, Bartolotta TV, Midiri M, Renda D, Maggio A. Cardiac complications in thalassemia: non-invasive detection methods and new directions in clinical management. Expert Rev Cardiovasc Ther. 2003;1(3):439-50. [Google Scholar][Crossref]
  12. Kliegman RM, Behrman RE, Jenson HB, Stanton BF, DeBaun MR, Vichinsky E. Nelson textbook of pediatrics. 18th ed. Philadelphia: Saunders; 2007. p. 1978. [Google Scholar][Crossref]
  13. Hay WW, Hayward AR, Sondheimer JM, Deterding RR. Current pediatric diagnosis and treatment. 14th ed. Stamford (CT): Appleton & Lange; 1999. p. 737-8. [Google Scholar][Crossref]
  14. Davignon A, Rautaharju P, Boisselle E, et al. Normal ECG standards for infants and children. Pediatr Cardiol. 1979;1(2):123-31. [Google Scholar][Crossref]
  15. Fazal-ur-Rahman Khan, Mahsud MAJ. Frequency of heart failure in patients with beta thalassemia major. Gomal J Med Sci. 2006;4(2):46-50. [Google Scholar][Crossref]
  16. Aessopos A, Farmakis D, Karagiorga M, Voskaridou E, Loutradi A, Hatziliami A, et al. Cardiac involvement in thalassemia intermedia: a multicenter study. Blood. 2001;97(11):3411-6. [Google Scholar][Crossref]
  17. Muhsin A. Cardiac complications in a group of beta thalassemia major patients in Al-Mansour Teaching Hospital [dissertation]. Baghdad: University of Baghdad; 2002. [Google Scholar][Crossref]
  18. Borgna-Pignatti C, Rugolotto S, De Stefano P, Zhao H, Cappellini MD, Del Vecchio GC, et al. Survival and complications in patients with thalassemia major treated with transfusion and deferoxamine. Haematologica. 2004;89(10):1187-93. [Google Scholar][Crossref]
  19. Davis BA, O'Sullivan C, Jarritt PH, Porter JB. Value of sequential monitoring of left ventricular ejection fraction in the management of thalassemia major. Blood. 2004;104(1):263-9. [Google Scholar][Crossref]

How to Cite

Etaij, D. M. H., Beg, K. A. A. A., & Nasrawi, A. J. M. (2026). Cardiac Complications in Iraqi Children with Beta-Thalassemia Major: Association with Serum Ferritin and Chelation Adequacy. International Journal of Medical and All Body Health Research, 7(2), 216-222. https://doi.org/10.54660/IJMBHR.2026.7.2.216-222

Etaij, Dafer Mahammad Hussein, et al. "Cardiac Complications in Iraqi Children with Beta-Thalassemia Major: Association with Serum Ferritin and Chelation Adequacy." International Journal of Medical and All Body Health Research, vol. 7, no. 2, 2026, pp. 216-222. https://doi.org/10.54660/IJMBHR.2026.7.2.216-222.

Etaij, D. M. H., Beg, K. A. A. A. and Nasrawi, A. J. M. (2026) 'Cardiac Complications in Iraqi Children with Beta-Thalassemia Major: Association with Serum Ferritin and Chelation Adequacy', International Journal of Medical and All Body Health Research, 7(2), pp. 216-222. doi: 10.54660/IJMBHR.2026.7.2.216-222.

Etaij DMH, Beg KAAA, Nasrawi AJM. Cardiac Complications in Iraqi Children with Beta-Thalassemia Major: Association with Serum Ferritin and Chelation Adequacy. International Journal of Medical and All Body Health Research. 2026;7(2):216-222. doi:10.54660/IJMBHR.2026.7.2.216-222

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