Endocrine Complications and the Effect of Compliance with Chelation Therapy in Patients with Beta Thalassemia Major in Eastern Province of Saudi Arabia

Abstract

Background

Endocrinopathies and metabolic complications are common in beta thalassemia major patients receiving blood transfusions. Chelation therapy has a role in preventing or delaying such complications. However, patients may face difficulties adhering to chelation therapy for several reasons.

Aim

To evaluate endocrine complications in beta thalassemia major patients (2–30 years) in the Eastern Province of Saudi Arabia and compare the onset of endocrine complications among compliant and noncompliant patients. Moreover, we assessed the barriers that hinder compliance with chelating therapy.

Methods

A cross-sectional study was conducted on 89 patients (43 males and 46 females) aged 2 to 30 years attending different hospitals in the Eastern Province of Saudi Arabia. A semi-structured questionnaire was used to collect demographic data and medical histories. The questionnaires were completed by face-to-face interviews with the patients or their caregivers, and the required laboratory data were retrieved from the medical records of patients.

Results

The most prevalent abnormality was underweight detected in (40.9%) of patients, followed by subclinical hypothyroidism (37.7%), short stature (35.2%), hypothyroidism in (17.0%) and diabetes mellitus in (13.6%). A significant difference between those who were compliant with iron chelation therapy and those who were not in terms of the prevalence of short stature (P value=0.05) and hypothyroidism (P value=0.05). The percentage of patients who were not compliant with chelation therapy was 21.6% and 9.1% of patients were not taking them at all.

Conclusion

Despite the role of chelation therapy in the management of iron overload, the risk of secondary endocrine and metabolic complications remained considerable. Subclinical hypothyroidism and short stature were the most frequent endocrine complications encountered in this study.

Keywords:

• iron overload
• metabolic complications
• hereditary blood diseases
• blood transfusions

Data Sharing Statement

A semi-structured questionnaire was used to collect demographic data and medical histories. The questionnaires were completed by face-to-face interviews with the patients or their caregivers, and the required laboratory data were retrieved from the medical records of patients attending hematology clinics across four different centers in Eastern Province, Saudi Arabia.

Ethics Approval and Consent to Participate

This study complies with the declaration of Helsinki. The research and ethical committee of Arabian Gulf University approved the research. Signed written consent was obtained from all participants above the age of 18 and from the caregivers of participants who were below 18 (Appendix 12).

Consent for Publication

The authors affirm that the participants provided informed consent for publication.

Acknowledgments

Our team would like to extend its deepest appreciation and recognition to a number of individuals and organizations, to which the success and outcome of this research would not have been possible had it not been for their help and supervision. Our team would first and foremost, like to thank Dr. Fatima Ebrahim Habbash for providing us with all the information and support needed to conduct and write this research. Her constant feedback and encouragement helped us to reach our goal, to which we are indebted to her. We owe our respects to Saudi Arabia’s Ministry of Health for giving us permission to interview the patients in the mentioned hospitals. Furthermore, Dr. Muneer Albagshi the head of the department of the Hereditary Disease Centre in Al-Ahsa’a welcomed us and asked the 21 working team to cooperate with us to facilitate our data collection. We also highly appreciate the help from Dr. Abdulmohsin Aljasim, who introduced us to the facilities and services provided by the hematology department and helped us in the retrieval of the laboratory investigations that we required in our study. We also appreciate Al-Qatif Central Hospital’s administration, the nurse team, and the research department for their collaboration. In addition, we thank King Fahad University Hospital and pediatrics unit for offering us an online course on ethics and morality before interviewing the patients. A special thanks to Dr. Mona AlSaleh, consultant pediatrician at King Fahad Hospital University. Dr. Hawazen Shash, consultant pediatrician at King Fahad Hospital University. Dr. Osama AlSultan, consultant internist at King Fahad Hospital University.

Disclosure

The authors have declared that no competing interests exist. The products used for this research are commonly and predominantly used products in our area of research and country. There is absolutely no conflict of interest between the authors and producers of the products because we do not intend to use these products as an avenue for any litigation but for the advancement of knowledge. Additionally, the research was not funded by the producing company rather it was funded by the personal efforts of the authors.