Factors Affecting Adherence to Iron Chelation Therapy in Thalassemia Major Patients
DOI:
https://doi.org/10.37762/jgmds.13-3.910Keywords:
Thalassemia Major, Iron Chelation Therapy, Adherence, Ferritin, Compliance, PakistanAbstract
ABSTRACT
OBJECTIVES
This study aimed to determine the factors affecting adherence to iron chelation therapy among patients with thalassemia major.
METHODOLOGY
This is a cross-sectional analytical study conducted at a tertiary care hospital. 97 patients with 97 cases of 2 thalassemia major were recruited using a non-probability, consecutive sampling method. The structured questionnaire and medical record review were used to collect data. Compliance was classified as good, moderate, and poor. SPSS version 25 was used to analyze the data. Associations were tested using the chi-square test, and p-values of 0.05 or less were considered statistically significant..
RESULTS
The mean age of participants was 15.6 ± 7.0 years. Good adherence was observed in 46.4% of patients, while 53.6% showed suboptimal adherence. No statistically significant association was found between adherence and demographic or clinical variables (p > 0.05). The most common reasons for non-adherence were forgetfulness (28.8%) and painful injections (25.0%), followed by high cost of therapy (19.2%) and side effects (17.3%).
CONCLUSION
Adherence to iron chelation therapy is suboptimal among thalassemia patients and is mainly influenced by behavioral and treatment-related factors. Strategies focusing on patient education, adherence support, and simplified treatment regimens are essential to improve compliance and clinical outcomes.
Downloads
Metrics
References
Zabadi HA, Ieran Z, Taha I. Assessment of adherence to iron chelation therapy among thalassemia patients in Palestine. Anemia. 2025;2025:6649477. https://doi.org/10.1155/2025/6649477 DOI: https://doi.org/10.1155/anem/6649477
Eziefula C, Shah FT, Anie KA. Promoting adherence to iron chelation treatment in beta-thalassemia patients. Patient Prefer Adherence. 2022;16:1423-1437. https://doi.org/10.2147/PPA.S347831. PMID: 35685284
Al-Jabory MA, Gatea AK, Hussein QN. Assessment of iron chelation therapy adherence in patients with thalassemia major in Babylon Province. J Appl Hematol. 2023;14(4):215-221. https://doi.org/10.4103/joah.joah_95_23 DOI: https://doi.org/10.4103/joah.joah_90_23
Keowmani T, Teo SC, Yap KC, Chua WL, Mohd Tahir NF, Chua PW, Lim YN, et al. Adherence to iron chelation therapy among children with beta-thalassemia major: a multicenter cross-sectional study. Hemoglobin. 2023;47(6):237-244. https://doi.org/10.1080/03630269.2023.2292847. PMID: 38157177 DOI: https://doi.org/10.1080/03630269.2023.2295291
Kwiatkowski JL. Clinical challenges with iron chelation in beta-thalassemia. Hematol Oncol Clin North Am. 2023;37(2):379-391. https://doi.org/10.1016/j.hoc.2022.11.010. PMID: 36774296 DOI: https://doi.org/10.1016/j.hoc.2022.12.013
Babamohammadi A, Wang Q, Mohajeri E, Esmaeilian S. Sociodemographic determinants of adherence and treatment efficacy in paediatric thalassemia patients from Sarbaz-Rask, Iran. Thalass Rep. 2024;14(3):60-70. https://doi.org/10.3390/thalassrep14030009 DOI: https://doi.org/10.3390/thalassrep14030008
Habbash F, Al-Bati W, Al-Hashim H, Aldossari M, Alali A, Alalyani K, et al. Endocrine complications and the effect of compliance with chelation therapy in patients with beta-thalassemia major in Eastern Province of Saudi Arabia. J Blood Med. 2022;13:763-774. https://doi.org/10.2147/JBM.S386508. PMID: 36523574 DOI: https://doi.org/10.2147/JBM.S386594
Mehrabadi F, Arian M, Badiee Z. Effect of therapy reminder application on treatment adherence in adults with beta-thalassemia major: a randomized clinical trial. Iran J Med Sci. 2025;50(9):597-606
Locke M, Reddy PS, Badawy SM. Adherence to iron chelation therapy among adults with thalassemia: a systematic review. Hemoglobin. 2022;46(4):201-213. https://doi.org/10.1080/03630269.2022.2106392. PMID: 35952388 DOI: https://doi.org/10.1080/03630269.2022.2072320
Theppornpitak K, Trakarnsanga B, Lauhasurayotin S, Poparn H, Chiengthong K, Sosothikul D, et al. A study to assess and improve adherence to iron chelation therapy in transfusion-dependent thalassemia patients. Hemoglobin. 2021;45(3):171-174. https://doi.org/10.1080/03630269.2021.1945037. PMID: 34227462
Musallam KM, Cappellini MD, Porter JB, Farmakis D, Eleftheriou A, Angastiniotis M, et al. TIF guidelines for the management of transfusion-dependent β-thalassemia. HemaSphere. 2025;9(3):e70095. https://doi.org/10.1097/HS9.0000000000007095 DOI: https://doi.org/10.1002/hem3.70095
Lee Wan J, Nurul Ain Mohd T, Farida I, Li SC. Adherence and health-related quality of life of transfusion-dependent thalassemia patients. Arch Pharm Pract. 2023;14(4):89-95 DOI: https://doi.org/10.51847/LXofvYDvl2
Kanwal M, Raza S. Predictors of non-adherence to iron chelation therapy in pediatric thalassemia patients. J Rawalpindi Med Coll. 2022;26(Suppl 1):73-78 DOI: https://doi.org/10.37939/jrmc.v1i1.1840
Chawsamtong S, Jetsrisuparb A, Kengkla K, Jaisue S. Effect of drug use calendar on adherence to iron chelation therapy in young thalassemia patients. Pharm Pract (Granada). 2022;20(1):2570. https://doi.org/10.18549/PharmPract.2022.1.2570. PMID: 35464153 DOI: https://doi.org/10.18549/PharmPract.2022.1.2570
Mohamed R, Abdul Rahman AH, Masra F, Abdul Latiff Z. Barriers to adherence to iron chelation therapy among adolescents with transfusion-dependent thalassemia. Front Pediatr. 2022;10:881246. https://doi.org/10.3389/fped.2022.881246. PMID: 35647065 DOI: https://doi.org/10.3389/fped.2022.951947
Reddy PS, Locke M, Badawy SM. A systematic review of adherence to iron chelation therapy among children and adolescents with thalassemia. Ann Med. 2022;54(1):326-342. https://doi.org/10.1080/07853890.2022.2031695. PMID: 35143258 DOI: https://doi.org/10.1080/07853890.2022.2028894
Lee WJ, Mohd Tahir NA, Chun GY, Li SC. The impact of chelation compliance on health outcomes and health-related quality of life in thalassemia patients: a systematic review. Health Qual Life Outcomes. 2024;22(1):14. https://doi.org/10.1186/s12955-024-02283-1. PMID: 38216574 DOI: https://doi.org/10.1186/s12955-023-02221-y
Ansari AH, Ansari SH, Salman MJ, Ansari MUH, Jabeen R. A scoping review on the obstacles faced by beta-thalassemia major patients in Pakistan: matter of policy investment. AIMS Public Health. 2024;11(4):1105-1124. https://doi.org/10.3934/publichealth.2024052. PMID: 39521781 DOI: https://doi.org/10.3934/publichealth.2024057
Eziefula C, Shah FT, Anie KA. Promoting adherence to iron chelation treatment in beta-thalassemia patients. Patient Prefer Adherence. 2022;16:1423-1437. https://doi.org/10.2147/PPA.S347831. PMID: 35685284 DOI: https://doi.org/10.2147/PPA.S269352
Siddiqui F, Hewitt C, Jennings H, Coales K, Mazhar L, Boeckmann M, Siddiqi N. Self-management of chronic, non-communicable diseases in South Asian settings: a systematic mixed-studies review. PLoS Glob Public Health. 2024;4(1):e0001668. https://doi.org/10.1371/journal.pgph.0001668. PMID: 38239265 DOI: https://doi.org/10.1371/journal.pgph.0001668
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Ghazala, Kainaat, Ihtisham Ul Haq , Bibi Asma, Jawairia Gul , Anhum Khan
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
