Liver Enzymes in Children with beta-Thalassemia Major: Correlation with Iron Overload and Viral Hepatitis


  • Khaled M. Salama Faculty of Medicine, Cairo University, Cairo
  • Ola M. Ibrahim National Research Center, Child Health Department, El Buhouth st., Dokki, Cairo 12311
  • Ahmed M. Kaddah Faculty of Medicine, Cairo University, Cairo
  • Samia Boseila National Research Center, Child Health Department, El Buhouth st., Dokki, Cairo 12311
  • Leila Abu Ismail National Research Center, Child Health Department, El Buhouth st., Dokki, Cairo 12311
  • May M. Abdel Hamid National Research Center, Child Health Department, El Buhouth st., Dokki, Cairo 12311



Beta thalassemia, egyptian children, viral hepatitis, iron overload, liver enzymes


BACKGROUND: Beta Thalassemia is the most common chronic hemolytic anemia in Egypt (85.1%) with an estimated carrier rate of 9-10.2%. Injury to the liver, whether acute or chronic, eventually results in an increase in serum concentrations of Alanine transaminase (ALT) and Aspartate transaminase (AST).

AIM: Evaluating the potentiating effect of iron overload & viral hepatitis infection on the liver enzymes.

PATIENTS AND METHODS: Eighty (80) thalassemia major patients were studied with respect to liver enzymes, ferritin, transferrin saturation, HBsAg, anti-HCV antibody and HCV-PCR for anti-HCV positive patients.

RESULTS: Fifty % of the patients were anti-HCV positive and 55% of them were HCV-PCR positive. Patients with elevated ALT and AST levels had significantly higher mean serum ferritin than those with normal levels. Anti-HCV positive patients had higher mean serum ferritin, serum ALT, AST and GGT levels and higher age and duration of blood transfusion than the negative group. HCV-PCR positive patients had higher mean serum ferritin and serum ALT and also higher age and duration of blood transfusion than the negative group.

CONCLUSION: Iron overload is a main leading cause of elevated liver enzymes, and presence of HCV infection is significantly related to the increased iron overload.


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Luz A, Sans M, Kimura E, Albuquerque D, et al. α-Thalassemia, HbS, and β-globin gene cluster haplotypes in two Afro-Uruguayan sub-populations from northern and southern Uruguay. Genet Mol Biol. 2006; 29: 595-600.

Karimi M, Ghavanini AA, and Kadiva MR. Regional mapping of the Gene frequency of β-Thalassemia in Fars Province, Iran during 1997-1998. Iran J Med Sci. 2000; 25(3&4):134-137.

Ameli M, Besharati S, Nemati K, Zamani F. Relationship between elevated liver enzyme with iron overload and viral hepatitis in thalassemia major patients in Northern Iran. Saudi Med J. 2008; 29(11):1611-5.

Ardalan FA, Osquei MR, Toosi MN, Irvanloo G. Synergic effect of chronic hepatitis C infection and beta thalassemia major with marked hepatic iron overload on liver fibrosis: a retrospective cross-sectional study. BMC Gastroenterol. 2004;4:17.

Papanikolaou G, Tzilianos M, Christakis JI, Bogdanos D et al., Hepcidin in iron overload disorders. Blood. 2005; 105: 4103-4105.

Feld J, Lee JY, Locarnini S. New targets and possible new therapeutic approaches in the chemotherapy of chronic hepatitis B. Hepatology. 2003;38(3):545–53.

Khalifa AS, El-Sayed MH, Moustafa AO, Mohammed MM, Rady MS, Salama II. Hepatitis C virus infection in children with hematological diseases: risk factors and reliability of diagnosis assays. Egypt J Pediatr. 2002;19: 293–308.

Omar N, Salama K, Adolf S, El-Saeed GS, et al. Major risk of blood transfusion in hemolytic anemia patients. Blood Coagul Fibrinolysis. 2011; 22(4): 280–4.

El-Faramawy A, El-Rashidy O, Tawfik P, Hussein G. Transfusion Transmitted Hepatitis: Where Do We Stand Now? A One Center Study in Upper Egypt. Hepat Mon. 2012;12(4): 286-291.

Li CK, Chik K, Lam C, To K et al., Liver disease in transfusion dependent thalassemia major. Arch Dis Child. 2002; 86:344-7.

Cunningham M, Macklin E, Neufeld E, Cohen AR. Thalassemia Clinical Research Network. Complications of β-thalassemia major in North America. Blood. 2004; 104:34-39.

Angelucci E, Muretto P, Nicolucci A, Baronciani D et al. Effects of iron overload and hepatitis C virus positivity in determining progression of liver fibrosis in thalassemia following bone marrow transplantation. Blood. 2002; 100:17-21.

Di Marco V, Capra M, Gagliardotto F, Borsellino Z et al. Liver disease in chelated transfusion-dependent thalassemics: the role of iron overload and chronic hepatitis C. Haematologica. 2008; 93(8):1243–1246.

Dimitrios K, Nikolaos J. Tsagarakis, Evangelia F, Efthimios D, et al. Liver disease in adult transfusion -dependent beta-thalassaemic patients: investigating the role of iron overload and chronic HCV infection. Liver International. 2013; 33(3): 420–427.

Edoardo G, Testa R, Savarino V. Liver enzyme alteration: a guide for clinicians. CMAJ. 2005; 172(3): 367–379.

Ng RH, Brown BA, Valdes R Jr. Three commercial methods for serum ferritin compared and the high-dose "hook effect" eliminated. Clin Chem. 1983;29(6):1109-13.

Burtis CA, Ashford E. Editors, Tietz Textbook of Clinical Chemistry, 2nd ed., Saunders, 1994: 2195.

International federation of clinical chemistry. J Clin Chem Clin Bio. 1980; 18:5231.

Bergmeyer HU. Principles of enzymatic analysis. Verlag chemie (Bergmeyer, H. U., ed.), 1978: 35-40.

Szasz G. New substrates for measuring gamma-glutamyl transpeptidase activity. Z Klin Chem Klin Biochem. 1974;12(5):228.

Hurie M, Mast E, Davis J. Horizontal transmission of hepatitis B virus infection to U.S. born children of Hmong refugees. Pediatrics. 1992; 89: 269-273.

Choo QL, Weiner AJ, Overby Lr, Kuo G et al. Hepatitis C virus: the major causative agent of viral non-A, non-B hepatitis. Br Med Bull. 1990;46:423-441.

Al-Salem AH, Nasserulla Z. Splenectomy for children with thalassemia. Int Surg. 2002; 87: 269-73.

Morsy M, Alnajar A, Almuzainy I, Alhawsawi Z et al. Splenectomized versus non-splenectomized thalassemia patients with thalassemia major. Echocardiographic comparison. Saudi Med J. 2008; 29: 1310-1314.

Taher A, Sheikh-Taha M, Koussa S, Inati I, et al. Comparison between desferrioxamine and deferiprone (L1) in iron-loaded thalassaemia patients. European Journal of Haematology. 2001; 67: 30–34.

Pennell DJ, Berdoukas V, Karagiorga M, Ladis V et al. Randomized controlled trial of deferiprone or deferoxamine in beta-thalassemia major patients with asymptomatic myocardial siderosis. Blood. 2006; 107: 3738–3744.

Galanello R and Campus S. Defriprone chelation therapy for thalassemia major. Acta Haematol. 2009; 122:155-164.

El-Alfy MS, Sari TT, Lee CL, Tricta F, El-Beshlawy A. The safety, tolerability, and efficacy of a liquid formulation of deferiprone in young children with transfusional iron overload. J Pediatr Hematol Oncol. 2010;32(8):601-5.

El-Beshlawy A, Mokhtar G, Abd El Ghafar E, Abd El Dayem MS et al. Assessment of Puberty in Relation to L-carnitine and Hormonal Replacement Therapy in β-thalassemic Patients. J Trop Pediatr. 2008; 54: 375-381.

Megahed S, Tayel S, Abdelrahim M, Ali A et al. Role of L-Carnitine in Treatment of β-Thalassemia Major Disease. Journal of Pediatric Sciences. 2011; 3(3):91.

Ruhl CE, Everhart JE. Relation of elevated serum alanine aminotransferase activity with iron and antioxidant levels in the United States. Gastroenterology. 2003; 124: 1821-1829.

El Gawhary S, Omar N, Abdel Rahman L, Mahmoud M. Hepatic viruses screening in multitransfused Egyptian thalassemia patients. J Arab Child. 2009;20(3):193–202.

Din G, Malik S, Ali I , Ahmed S ,and Dasti JI. Prevalence of hepatitis C virus infection among thalassemia patients: a perspective from a multi-ethnic population of Pakistan. Asian Pac J Trop Med. 2014;7S1:S127-33.

Mansour AK, Aly RM, Abdelrazek SY, Elghannam DM, Abdelaziz SM, Shahine DA, Darwish AM, Elmenshawy NM. Prevalence of HBV and HCV infection among multi-transfused Egyptian thalassemic patients. Hematol Oncol Stem Cell Ther. 2012;5(1):54-9.

Hussein E. Evaluation of infectious disease markers in multitransfused Egyptian children with thalassemia. Ann Clin Lab Sci. 2014;44(1):62-6.

El-Shanshory MR, Kabbash IA, Soliman HH, Nagy HM, Abdou SH. Prevalence of hepatitis C infection among children with β-thalassaemia major in Mid Delta, Egypt: a single centre study. Trans R Soc Trop Med Hyg. 2013;107(4):224-8.

Ocak S, Kaya H, Cetin M, Gali E et al. Seroprevalence of hepatitis B and hepatitis C in patients with thalassemia and sickle cell anemia in a long-term follow-up. Arch Med Res. 2006;37(7):895–8.



How to Cite

Salama KM, Ibrahim OM, Kaddah AM, Boseila S, Ismail LA, Abdel Hamid MM. Liver Enzymes in Children with beta-Thalassemia Major: Correlation with Iron Overload and Viral Hepatitis. Open Access Maced J Med Sci [Internet]. 2015 May 28 [cited 2022 Aug. 13];3(2):287-92. Available from:



B - Clinical Sciences

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