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A Longitudinal Study of Growth and Relation With Anemia and Iron Overload in Pediatric Patients With
Kwannapas Nokeaingtong1, Pimlak Charoenkwan, Suchaya Silvilairat
1*Department of Pediatrics, Faculty of Medicine†Department of Radiologic Technology, Faculty of Associated Medical Sciences‡Biomedical Engineering Center, Faculty of Engineering, Chiang Mai University, Chiang Mai, Thailand.
Insights
Short stature is common in children with transfusion-dependent thalassemia (TDT). Growth faltering is linked to increasing age, male sex, lower hemoglobin, and iron overload, impacting height-for-age Z-scores.
Area of Science:
- Pediatric Endocrinology
- Hematology
- Growth and Development
Background:
- Short stature is a frequent complication in transfusion-dependent thalassemia (TDT).
- Understanding growth patterns and associated factors is crucial for managing TDT patients.
Purpose of the Study:
- To investigate the longitudinal growth trajectory in pediatric TDT patients.
- To identify clinical factors associated with short stature in this population.
Main Methods:
- Analysis of height-for-age Z-scores (HAZ) in 50 TDT patients using linear mixed models.
- Evaluation of associations between HAZ and factors like hemoglobin, ferritin levels, and cardiac iron overload.
Main Results:
- 38% of patients exhibited short stature (HAZ ≤ -2.0), with prevalence increasing with age.
- Mean HAZ declined significantly with age (0.19 SD/year from age 5 to 14).
- Short stature was associated with male sex, low hemoglobin, high ferritin, and cardiac T2* ≤ 20 ms.
Conclusions:
- Short stature is a significant concern in pediatric TDT.
- Growth is negatively impacted by age, male sex, anemia, and iron overload, particularly cardiac iron deposition.
Abstract:
Short stature is one of the most common endocrinopathies in transfusion-dependent thalassemia (TDT). This study aimed to determine the longitudinal pattern of growth in pediatric patients with TDT and study the relationship between growth and hemoglobin level, serum ferritin level/iron overload parameters, and other clinical factors. The interval height-for-age Z-scores (HAZ) of 50 patients with TDT, of a mean age of 13.3±2.8 years, were analyzed using linear mixed model analysis. Nineteen patients (38%) had short stature with HAZ≤-2.0. The prevalence of short stature increased with age. The estimated mean HAZ decreased by 0.19 SD per year from the age of 5 years until approximately 14 years (95% confidence interval [CI], -0.22 to -0.16, P<0.001). Male sex (estimate, -0.28; 95% CI, -0.43 to -0.14; P<0.001), mean 3-year hemoglobin level ≤8 g/dL (estimate, -0.36; 95% CI, -0.53 to -0.19; P<0.001), mean 3-year ferritin level ≥1800 ng/mL (estimate, -0.44; 95% CI, -0.59 to -0.29; P<0.001), and cardiac T2* ≤20 ms (estimate, -1.05; 95% CI, -1.34 to -0.77; P<0.001) were significantly associated with short stature. In conclusion, short stature in patients with TDT is common and relates significantly with increasing age, male sex, hemoglobin level, and iron overload status.
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