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Although numerous patient‐specific co‐factors have been shown to be associated with worse outcomes in COVID‐19, the prognostic value of thalassaemic syndromes in COVID‐19 patients remains poorly understood. We studied the outcomes of 137 COVID‐19 patients with a history of transfusion‐dependent thalassaemia (TDT) and transfusion independent thalassaemia (TIT) extracted from a large international cohort and compared them with the outcomes from a matched cohort of COVID‐19 patients with no history of thalassaemia. The mean age of thalassaemia patients included in our study was 41 ± 16 years (48.9% male). Almost 81% of these patients suffered from TDT requiring blood transfusions on a regular basis. 38.7% of patients were blood group O. Cardiac iron overload was documented in 6.8% of study patients, whereas liver iron overload was documented in 35% of study patients. 40% of thalassaemia patients had a history of splenectomy. 27.7% of study patients required hospitalization due to COVID‐19 infection. Amongst the hospitalized patients, one patient died (0.7%) and one patient required intubation. Continuous positive airway pressure (CPAP) was required in almost 5% of study patients. After adjustment for age‐, sex‐ and other known risk factors (cardiac disease, kidney disease and pulmonary disease), the rate of in‐hospital complications (supplemental oxygen use, admission to an intensive care unit for CPAP therapy or intubation) and all‐cause mortality was significantly lower in the thalassaemia group compared to the matched cohort with no history of thalassaemia. Amongst thalassaemia patients in general, the TIT group exhibited a higher rate of hospitalization compared to the TDT group (p = 0.001). In addition, the rate of complications such as acute kidney injury and need for supplemental oxygen was significantly higher in the TIT group compared to the TDT group. In the multivariable logistic regression analysis, age and history of heart or kidney disease were all found to be independent risk factors for increased in‐hospital, all‐cause mortality, whereas the presence of thalassaemia (either TDT or TIT) was found to be independently associated with reduced all‐cause mortality. The presence of thalassaemia in COVID‐19 patients was independently associated with lower in‐hospital, all‐cause mortality and few in‐hospital complications in our study. The pathophysiology of this is unclear and needs to be studied in vitro and in animal models.

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Oxidative stress in β-TM (beta-thalassemia major) patients is associated with increased of malondialdehyde (MDA) level and also decreased of superoxide dismutase (SOD) level. Deferiprone and deferasirox, which are used for the treatment of iron overload, exhibit antioxidant potential. However, various clinical studies have shown an increase in creatinine levels in pediatric patients receiving oral iron chelator. There was limited study assessed oxidative stress and impact of β-TM on the renal function, especially in children that growing up with β-TM and receiving iron chelator. Therefore, the aim of the study is to investigate renal function and oxidative stress between β-TM patients at Ulin Hospital Banjarmasin who received deferasirox and deferiprone. Ninety β-TM patients (aged 2-≤18 years) with regular iron chelators (deferiprone or deferasirox) use at Ulin Hospital between October-December 2020, were included in this cross-sectional study. Laboratory examinations included complete peripheral blood count, serum ferritin, urea, creatinine, MDA and SOD. Statistical analysis was used to compare all parameters between two groups.There was no significant difference in the levels of MDA (p= 0.663), SOD (p= 0.102), urea (p= 0.597), creatinine (p= 0.067) and glomerular filtration rate (p= 0.792) between the two groups. In this study, 9 patients had decreased GFR, of which 3 patients (33.3%) were taking DFX. Thus, 13.6% of DFX users (3 of 22 patients) and 8.8% of DFP users (6 of 68 patients) had decreased renal function. In general, the mean glomerular filtration rate (GFR) of the patients in this study ranged from 126.74± 32.71ml/kg/min/1.73m2. For conclusion, deferiprone and deferasirox had no significant difference in terms of protection against oxidative stress. However, the decline in renal function occurred slightly higher in deferasirox users. Early recognition will be an important key to prevent renal complication

BackgroundFerritin has been recognized as a predictor of severity among Coronavirus-19 disease (COVID-19) patients. Studies have shown higher levels of ferritin in patients with COVID-19 than in healthy children. Patients with transfusion-dependent thalassemia (TDT) basically have high ferritin level due to iron overload. It is uncertain whether serum ferritin level in these patients is associated with COVID-19 infection.ObjectiveTo evaluate ferritin levels in TDT with COVID-19 before, during, and after the course of infection.MethodsThis retrospective study enrolled all TDT children with COVID-19 infection that were hospitalized in Ulin General Hospital Banjarmasin during the COVID-19 pandemic (March 2020 to June 2022). Data were collected from medical records.ResultsThere were 14 patients included in this study, 5 patients had mild symptoms and 9 patients were asymptomatic. The mean of hemoglobin level upon admission was 8.1 ± 3 g/dL and serum ferritin level were 5148.5 ± 2651.8 ng/mL. The average serum ferritin level during COVID-19 infection was 2373.2 ng/mL higher than before infection and then decreased by 952.4 ng/mL after infection. We found no association of increasing serum ferritin with patients’ symptoms (p = 0.27). The severity of anemia also was not correlated with the presentation of COVID-19 infection (p = 0.902).ConclusionSerum ferritin levels in TDT children may not reflect disease severity or predict poor outcomes during COVID-19 infection. However, the presence of other co-morbid conditions/confounders warrants cautious interpretation.

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