Predictive Biomarker of Hepatitis B and C Infection among Thalassemia Patients in Faisalabad, Punjab, Pakistan

Abstract

Background: Transfusion-dependent β-thalassemia patients are particularly susceptible to transfusion-transmitted infections, especially hepatitis B virus (HBV) and hepatitis C virus (HCV), owing to lifelong dependence on repeated blood transfusions. Chronic viral hepatitis, together with transfusion-related iron overload, contributes substantially to progressive liver injury and adverse hematological outcomes. This study investigated the association between HBV and HCV infections and biochemical as well as hematological parameters in transfusion-dependent β-thalassemia patients and identified significant predictors of hepatic involvement. Methods: A cross-sectional analytical study was conducted among transfusion-dependent β-thalassemia patients attending a specialized thalassemia care center in Faisalabad, Punjab, Pakistan. Participants were categorized into four groups: non-infected, HBV-infected, HCV-infected, and HBV/HCV co-infected. Demographic characteristics, clinical history, biochemical markers including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and serum bilirubin, together with hematological indices, were recorded. Statistical analyses were performed using SPSS version 26. Descriptive statistics, correlation analysis, chi-square tests, independent-samples t-tests, and logistic regression analyses were employed to identify significant predictors of hepatitis infection. Results: Hepatitis infection was significantly associated with an increased number of blood transfusions. Patients with HBV, HCV, and particularly HBV/HCV co-infection demonstrated significantly elevated AST, ALT, and serum bilirubin concentrations compared with non-infected patients (p < 0.01). Positive correlations were observed between transfusion frequency and liver enzyme levels. Significant alterations were also identified in hematological indices, including mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and red cell distribution width (RDW), whereas total white blood cell counts showed no statistically significant differences. Logistic regression analysis identified the cumulative number of transfusions, AST, ALT, serum bilirubin, and hepatitis infection status as independent predictors of hepatic involvement, with HCV exhibiting the strongest association. Conclusions: Transfusion-dependent β-thalassemia patients remain at substantial risk of HBV and HCV infections despite advances in blood safety practices. Viral hepatitis significantly impairs liver function and alters hematological profiles, emphasizing the importance of rigorous donor screening, regular biochemical monitoring, timely antiviral management, and strengthened infection prevention strategies to reduce disease burden and improve long-term clinical outcomes.