Ultrasonographic assessment of the prevalence of cholelithiasis and biliary sludge in beta-thalassemia patients in Iran

Background: Thalassemia is a hereditary disease related to hemoglobin synthesis. The aim of this study was to determine the prevalence of gallbladder sludge and stones in beta-thalassemic children.
Material and Method: One hundred fifty-three beta-thalassemia patients on a long-term transfusion/chelation program were selected by a cluster randomized method and were evaluated ultrasonographically for the presence of sludge and biliary lithiasis. Relationships between the prevalence of gallbladder sludge and stones with age, sex, age at the start and the frequency of transfusion, mean pretransfusion Hb and ferritin levels, age at start of deferoxamine injection, splenectomy, and degree of splenomegaly were evaluated statistically.
Results: Gallstones and biliary sludge were detected in 12.4% and 13.1% of the patients, respectively. There was a significant increase in the prevalence of gallstones with increasing age, transfusion periods of <21 days, severe splenomegaly, splenectomy, and deferoxamine injection started after 5 years of age. Such a relationship was not detected for hemoglobin and ferritin levels. Multiple logistic regression analysis revealed that the frequency of transfusions and age at the start of deferoxamine injections were the only positive factors that predicted the subsequent development of gallstones.
Conclusions: Longer survival of beta-thalassemic patients leads to a higher prevalence gallbladder sludge and stones. Therefore a proper follow-up of patients with abdominal ultrasonography and improving the transfusion/chelation program should be mandatory.

Keywords: Regression Analysis, Prevalence, Iran - epidemiology, Cholelithiasis - ultrasonography, Child, Preschool, Child, Bile - ultrasonography, Adolescent, young adult, beta-Thalassemia - ultrasonography