Background: Ineffective erythropoiesis coupled with chronic anemia in thalassemic patients may lead
to increase gastrointestinal iron absorption which may result in liver fibrosis. Although liver biopsy is the gold
standard tool for the diagnosis of liver fibrosis, recent noninvasive tests may also help in the evaluation.
Objective: We aimed to compare the difference of liver stiffness measurement between transfusion
dependent and non-transfusion dependent thalassemia. We also assessed the prevalence of significant fibrosis and
attempted to identify factors that could be associated with significant fibrosis.
Methods: A cross-sectional assessment of liver fibrosis using transient elastography (TE) was performed
in 109 thalassemic patients were seen at the Hematology Unit and the Liver Unit, Ramathibodi Hospital over a 1-
year period. Baseline demographic data, anthropometry, type of thalassemia, history of chelation therapy and dose
of treatment, and related blood tests (CBC, LFT, ferritin, HBsAg, Anti HCV, Anti HIV) were collected. TE was
performed by standard technique. TE ≥ 7.9 kPa was defined as significant fibrosis. Statistical analysis appropriately
made using by Student t-test, Wilcoxon rank-sum test, and Spearman correlation or Chi-Square test. Factors
with p-value < 0.05 were selected for multivariate analysis.
Results: A total of 109 thalassemic patients (66 transfusion dependent and 43 non-transfusion dependent)
were enrolled. Most patients in both groups (77%) were female. The prevalence of significant fibrosis (TE ≥
7.9) in TDT and NTDT was 24.2% and 18.6%. All patients in TDT group were chelated, comparing with 66% in the
NTDT group. The median liver stiffness measurements in TDT vs. NTDT were 5.65 (2.5, 36.8) and 5.35 (3.2, 12.2)
(p= 0.535). From univariate analysis of significant fibrosis, the associated factors were male sex, non-chelation,
higher serum ferritin, AST, ALT and GGT (p< 0.05). However, ALT level was the only predictive factor for significant
fibrosis (OR 1.04, 95 % CI (1.01-1.06), p< 0.05).
Conclusion: The median liver stiffness did not significantly differ between transfusion dependent and
non-transfusion dependent thalassemia. The prevalence of significant liver fibrosis (TE ≥ 7.9 kPa) in thalassemia
patients was 22%. Serum ALT level was the only factor that appears to be associated with significant liver fibrosis.