Liver iron overload and hepatic function in children with thalassemia major

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Pustika Amalia Wahidiyat
Stephen Diah Iskandar
Ludi Dhyani Rahmartani
Damayanti Sekarsari


Background Routine blood transfusions and increased intestinal iron absorption lead to iron accumulation in various organs, especially the liver. To date, T2-star magnetic resonance imaging (T2*MRI) is a valuable tool to evaluate iron level in organs.

Objective To assess the degree of liver iron overload among children with thalassemia major (TM) and its possible correlations with hepatic function laboratory values.

Methods This cross-sectional study was conducted in Cipto Mangunkusumo Hospital. The degree of liver iron overload was evaluated by T2*MRI. Assessments of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, and bilirubin levels were done to evaluate liver function.

Results A total of 291 TM children were included in this study. The mean age of subjects was 12 years. Most of the subjects were diagnosed as β-thalassemia homozygote (54.6%) and β-thalassemia/HbE (41.2%). Deferiprone (DFP) was the most commonly used iron chelator. Less than 10% of the subjects had normal liver iron deposition. The AST and ALT values increased proportionally with the severity of liver iron overload, with significant, moderately negative correlation coefficients (r=-0.388 and -0.434, respectively). However, albumin level decreased proportionally with the severity of liver iron overload, with a significant, moderately positive correlation coefficient (r=0.323). Liver T2* MRI had no significant correlations with direct, indirect, and ratio of direct/total bilirubin levels.

Conclusion Most of the children with TM have mild to severe liver iron overload. Liver T2* MRI had significant, moderate correlations with AST, ALT, and albumin values. Bilirubin level has no correlation with T2* MRI. Our findings suggest that monitoring of AST, ALT, and albumin levels is important because they may reflect the severity of liver iron overload. However, they should not be used as the only predictors of iron overload.

Article Details

How to Cite
Wahidiyat P, Iskandar S, Rahmartani L, Sekarsari D. Liver iron overload and hepatic function in children with thalassemia major. PI [Internet]. 27Sep.2018 [cited 25Jul.2021];58(5):233-. Available from:
Pediatric Hemato-Oncology
Received 2018-06-13
Accepted 2018-09-25
Published 2018-09-27


1. Fucharoen S, Winichagoon P. Haemoglobinopathies in Southeast Asia. Indian J Med Res. 2011;134:498-506.
2. Langhi D, Ubiali EMA, Marques JFC, Verissimo MA, Loggetto SR, Silvinato A, et al. Guidelines on Beta-thalassemia major – regular blood transfusion therapy: Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular: project guidelines: Associação Médica Brasileira – 2016. Rev Bras Hematol Hemoter. 2016;38:341–5.
3. Anderson ER, Shah YM. Iron hemostasis in the liver. Compr Physiol. 2013;3:315-30.
4. Echeverria JMA, Castiella A, Emparanza JI. Quantification of iron concentration in the liver by MRI. Insights Imaging. 2012;3:173-80.
5. Eghbali A, Taherahmadi H, Shahbazi M, Bagheri B, Ebrahimi L. Association between serum ferritin level, cardiac and liverT2-star MRI in patients with major β-thalassemia. Iran J Ped Hematol Oncol. 2014;4:17-21.
6. Sirlin CB, Reeder SB. Magnetic resonance imaging quantification of liver iron. Magn Reson Imaging Clin N Am. 2010;18:359-81.
7. Kohgo Y, Ikuta K, Ohtake T, Torimoto Y, Kato J. Body iron metabolism and pathophysiology of iron overload. Int J Hematol. 2008;88:7-15.
8. Imam MU, Zhang S, Ma J, Wang H, Wang F. Antioxidants mediate both iron homeostasis and oxidative stress. Nutrients. 2017;9:671.
9. Gowda S, Desai PB, Hull VY, Math AA, Vernekar SN, Kulkarni SS. A review on laboratory liver function tests. Pan Afr Med J. 2009;3:17.
10. Kasarala G, Tillmann HL. Standard liver tests. Clin Liver Dis. 2016;8:13-8.
11. Giannini EG, Testa R, Savarino V. Liver enzyme alteration: a guide for clinicians. CMAJ. 2005;172:367-79.
12. Bernardi M, Maggioli C, Zaccherini G. Human albumin in the management of complication of liver cirrhosis. Crit Care. 2012;16:211.
13. Garcovich M, Zocco MA, Gasbarrini A. Clinical use of albumin in hepatology. Blood Transfus. 2009;7:268-77.
14. Thapa BR, Walia A. Liver function tests and their interpretation. Indian J Pediatr. 2007;74:663-71.