Publication: Liver Function Parameters and Validation of Health-Related Quality of Life Assessment of β-Thalassemia Cases at a Tertiary Care Hospital, Lumbini Province, Nepal
Date
2025
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Background
Individuals affected by β-thalassemia experience complications such as hepatic
hemosiderosis and fibrosis due to frequent blood transfusions, which can lead to
iron overload. Multiple blood transfusion burdens in thalassemia, particularly in low-
income countries, impact health-related quality of life.
Objective
Liver function parameters and health-related quality of life were assessed using
Nepali version 36 short-form survey instruments to reveal the vitality, physical,
mental, emotional, pain, general health, and social functioning of β-thalassemia
cases.
Method
In this cross-sectional study, forty β-thalassemia cases who had visited the Universal
College of Medical Sciences tertiary care teaching hospital of Lumbini Province,
Nepal were enrolled. The hemoglobin variant band percentage was estimated by
D-10 BioRad high performance liquid chromatography (HPLC), Mentzer Index (Mean
Cell Volume by Red Blood Cell count) by Beckman hematological analyzer, and
serum liver parameters (Bilirubin, Total protein, Albumin, Alanine aminotransferase,
Aspartate aminotransferase, Alkaline phosphatase) were estimated by using Diatron
fully automated analyzer. The internal consistency of the Nepali version of 36 short-
form survey instruments was checked by Cronbach`s alpha was found to be > 0.70
from the recoded value. Data are analyzed using the STATA/MP14, and ANOVA and
t-test are applied to test the significance considering p-value < 0.05.
Result
The frequency of the β-thalassemia Trait (60%) was higher than β-thalassemia Major
(30%) and 7.5% β-thalassemia Intermedia co-morbidities with Sickle cell (2.5%) and
β/δ variants (2.5%). Higher frequency was found in ethnic groups Muslim (32.5%)
followed by Terai indigenous-Tharu (30%) and Madheshi (27.5%). The transfusion-
dependent cases have significantly higher Total, Direct, Indirect Bilirubin, and
Alkaline phosphatase levels than non-transfusion dependent cases (p<0.001). The
physical functioning, general health, emotional health, and vitality were significantly
decreased in β-thalassemia Major as compared to β-thalassemia Trait (p<0.001), and
significantly correlated with Mentzer index and HPLC patterns (HBA2/HBF) (p<0.05).
Conclusion
Transfusion dependent β-thalassemia Major and Intermedia had elevated Bilirubin
and Alkaline phosphatase levels as compared to non-transfusion dependent
β-thalassemia Trait, exacerbating health-related quality of life, emphasizing the
preventable disparities for optimized transfusion protocols and psychosocial support.
KEY WORDS
β-thalassemia, Health-related quality of life, Liver function tests
Description
Gautam N,1 Risal P,2 Gupta RT,3 Agrawal KK,4 Chaudhary D,5 Paudel MS,6 Adhikari B,7 Pokhrel BR,1 Tamang B,1 Shrestha J,1 Sharma B,1 Ghimire S3
1Department of Biochemistry
Universal College of Medical Sciences
Bhairahawa, Nepal
2Department of Biochemistry
Kathmandu University School of Medical Sciences
Dhulikhel, Kavrepalanchok, Nepal
3Central Lab Services
4Department of Internal Medicine
5Department of Paediatrics
Universal College of Medical Sciences
Bhairahawa, Nepal
6Department of Gastroenterology
National Academy of Medical Sciences
Kathmandu, Nepal
7Mahidol-Oxford Tropical Medicine Research Unit
Bangkok, Thailand
Keywords
β-thalassemia, Health-related quality of life, Liver function tests