Assessment of Iron Chelation Therapy Adherence in Patients with Thalassemia Major in Babylon Province

Abstract

Abstract BACKGROUND: Thalassemia is severe public health problem in Iraq and other nearby countries, represents about 75% of all hemogloniopathy with prevalence and incidence 36/100.000 and 34/100.000 respectively. beta thalassemia major represented 67% of all types of thalassemia. In the absence of treatment, it cause bony deformities and hepatosplenomegaly. Bone marrow transplant is the only curative treatment, but it is restricted to only a few patients. As a result, the majority of patients also receive iron chelation therapy along with routine blood transfusions. Failure of chelation can result in endocrinopathies, cardiomyopathy, and hepatic failure, iron chelation therapy requires careful monitoring and high adherence to obtain acceptable therapeutic outcomes. The main factor causing morbidity and mortality in thalassemia is iron excess. Adherence is a complicated phenomenon that involves interconnected elements linked to each patient’s condition, therapy, and environment as well as psychological elements. OBJECTIVE: We assessed the adherence to iron chelation therapy in thalassemia major patients in Babylon province in Iraq and trying to identify the factors leading to poor adherence. MATERIALS AND METHODS: This is cross sectional study performed over the course of two months on 100 patients with β-thalassemia major registered at hereditary blood disease center, in Babylon, Iraq, using deferasirox as chelation agent by direct interview using a predesigned questionnaire. RESULT: Mean age was (14.93± 6.85) years, (61%) of patients were males. The great majority (97%) were single. (59%) of patients were below bachelor. (96%) were unemployed and about half of patients (51%) were rural. Number of affected family members range from 0 to 4, with only one affected member rank one. (92%) of them not use chronic medication other than chelating therapy and folic acid. Disease complication other than organomegaly present in 14% of patients, that include hepatitis C infection, delayed growth, diabetes mellitus and hypothyroidism. More than three-quarters of patients (79%) have good adherence for chelation therapy, were 21 patients have poor adherence, mostly secondary to gastrointestinal side effect (nausea, vomiting, stomach discomfort and bitter taste), or non-specific causes (disinterest, forgetfulness, feeling hassled and taking other medication). The mean duration from diagnosis was 13.6 years, transfusion duration was 13.4 years, transfusion frequency was about 23 days and chelating duration was 10.7 years. Mean of packed cell volume (PCV) was 22%, while mean of serum ferritin was 4342mg/ dl. There was significant association between mean PCV of patients and their adherence to chelating therapy P value was (0.009), other variable show non-significant association. CONCLUSION: Thalassemia major patients in Babylon governorate have good level of adherence to iron chelation therapy which was nearly comparable or even better than adherence rates in other Middle East countries. Despite that, the chelation is inadequate due to logistic issues.