The relationship between blood transfusion, iron overload and hepatotoxicity in children with sickle cell disease at the Kenyatta National Hospital: a cross-sectional study

Abstract

Background: Children with sickle cell disease (SCD) who undergo repeated blood transfusions are at an increased risk of iron overload which may cause hepatotoxicity. Using serum ferritin (SF) as a marker of iron stores, we sought to determine the prevalence of iron overload and its association with blood transfusions and liver function among children with sickle cell disease at Kenyatta National Hospital (KNH).
Methods: We conducted a cross-sectional study at KNH between June 2021 to October 2021. Through convenience sampling, children aged 1 – 18 years on follow-up for SCD were included. Participant demographics and blood transfusion histories for the past 3 years were recorded. A 3 ml venous blood sample was collected for assessment of SF and alanine aminotransferase levels (ALT). The association between SF levels, blood transfusions, and ALT levels was evaluated using logistic regression and the Mann Whitney test.
Results: We included 145 children, 59.3% male, with a median age of 8 years (IQR 4; 11 years). The median number of blood transfusions was 2 (IQR 0; 3). The prevalence of iron overload (measured by SF) was 64% while that of hepatotoxicity (measured by elevated ALT) was 9.7%. Each additional unit of transfused blood increased the likelihood of iron overload (OR 1.8; 95% CI 1.38,2.54, p value < 0.001). Every 1 ng/ml increase in SF was associated with a 0.1% (OR 1.001; 95% CI 1.001, 1.002, p value < 0.001) increase in serum ALT.
Conclusions: Children with SCD undergoing blood transfusion require careful monitoring to avoid hepatotoxicity.