Liver volume in thalassaemia major: relationship with body weight, serum ferritin, and liver function

Background: It is not known whether body weight alone can adjust for the volume of liver in the calculation of the chelating dose in beta-thalassaemia major patients, who frequently have iron overload and hepatitis. Objective: The hypothesis is that liver volume in children and adolescents suffering from beta-thalassaemia major is affected by ferritin level and liver function. Materials and methods: Thirty-five beta-thalassaemia major patients aged 7-18 years and 35 age- and sex-matched controls had liver volume measured by MRI. Serum alanine aminotransferase (ALT) and ferritin levels were obtained in the thalassaemia major patients. Results: Body weight explained 65 and 86% of the change in liver volume in beta-thalassaemia major patients and age-matched control subjects, respectively. Liver volume/kilogram body weight was significantly higher (P<0.001) in thalassaemia major patients than in control subjects. There was a significant correlation between ALT level and liver volume/kilogram body weight (r=0.55, P=0.001). Patients with elevated ALT had significantly higher liver volume/kilogram body weight (mean 42.9+/-12 cm(3)/kg) than control subjects (mean 23.4+/-3.6 cm(3)/kg) and patients with normal ALT levels (mean 27.4+/-3.6 cm(3)/kg).Conclusions: Body weight is the most important single factor for liver-volume changes in thalassaemia major patients, but elevated ALT also has a significant role. Direct liver volume measurement for chelation dose adjustment may be advantageous in patients with elevated ALT.