Transfusion, and reproductive health profiles of female patients with transfusion-dependent thalassaemia in Bangladesh: A cross-sectional study

Abstract

Background: Regular iron chelation therapy is critical to prevent iron overload complications in transfusion-dependent patients. However, adherence remains suboptimal, thalassaemia is one of the most common inherited hemoglobin disorders worldwide, with a particularly high burden in South and Southeast Asia. Objectives: This study aimed to identify factors associated with irregular iron chelation therapy using chi-square and logistic regression analyses. Methods: A cross-sectional analysis was conducted on 85 female patients receiving iron chelation therapy. Chi-square tests were used to examine associations between chelation regularity (regular vs. irregular) and categorical predictors including transfusion interval, splenomegaly, splenectomy history, menstrual flow, delayed puberty, and type of chelation drug (deferoxamine, deferiprone, deferasirox). Binary logistic regression (unadjusted and adjusted for age, sex, and BMI) estimated odds ratios (ORs) with 95% confidence intervals (CIs). Results: This study revealed significant associations with chelation regularity for shorter transfusion interval (χ²=6.82, p<0.033), splenomegaly (χ²=5.14, p<0.023), and deferiprone use (χ²=5.78, p<0.016). No significant associations were found for splenectomy, menstrual flow, delayed puberty, deferoxamine, or deferasirox (p>0.05 for all). In unadjusted logistic regression, a 3-4 week transfusion interval (compared to >4 weeks) was associated with increased odds of irregular chelation (OR=2.03, 95% CI: 1.21–3.41, p<0.007); splenomegaly also increased odds (OR=2.81, 95% CI: 1.23–6.42, p<0.014); while deferiprone use was protective (OR=0.41, 95% CI: 0.21–0.80, p<0.009). After adjustment, all three remained significant: transfusion interval 3-4 weeks (AOR=1.92, 95% CI: 1.13–3.26, p<0.015), splenomegaly (AOR=2.45, 95% CI: 1.05–5.72, p<0.038), and deferiprone use (AOR=0.45, 95% CI: 0.23–0.88, p<0.020). Conclusion: This study revealed that shorter transfusion intervals (3-4 weeks) and splenomegaly are independent risk factors for irregular chelation adherence, whereas deferiprone use is associated with more regular therapy. These findings highlight the need for targeted adherence support in high-risk patients and suggest a potential compliance benefit with deferiprone. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2026;5(Suppl 1): S43]