Relation of ferritin levels to pulmonary function in patients with thalassemia major and the acute effects of transfusion

We studied 36 patients (17 males and 19 females) with thalassemia major by performing pulmonary function testing (PFT), arterial blood gas analysis (A BG), as well as determining the serum ferritin level. In addition, 19 of th ese patients were transfused with two units of packed cells, and a repeat A BG and PFT were performed. Twenty-three patients had normal PFTs, eleven pa tients (30.6%) showed a restrictive pattern (significant decrease in both T LC and DLCO), and only two patients (5.6%) showed an obstructive pattern. A significant negative correlation was found between serum ferritin and rest rictive parameters, DLCO and TLC (p=0.01 and p=0.03, respectively). This co rrelation was even stronger after transfusion. Controlling for age, ferriti n was still negatively correlated with DLCO (p=0.04), but no longer with TL C. There was no correlation between age and DLCO or age and TLC; however, t here was a statistically significant negative correlation between age and F VC (p=0.003). Analysis of patients who were transfused revealed a significa nt decrease in forced vital capacity (89 +/- 4% vs. 74 +/- 5% of predicted; p-value < 0.001) and in maximum midexpiratory flow rate (79 +/- 4% vs. 67 +/- 5% of predicted; p-value=0.004). For patients older than 15 yr of age, there was a statistically significant decrease in FEV1/FVC (84 +/- 2 vs. 83 +/- 2%; p-value=0.04). The ABGs showed no significant change posttransfusi on. In this study, PFT findings in thalassemia major were restrictive and c orrelated with serum ferritin level. Transfusion had an acute effect on the obstructive parameters of PFT.