Publication:

Comparison of serum homocysteine levels in transfusion-dependent β-thalassemia patients with regular and irregular folic acid supplementation

Background Transfusion-dependent β-thalassemia (TDT) patients have increased folate requirements due to chronic erythropoietic stress. Inadequate folate intake may result in elevated serum homocysteine, a recognized risk factor for vascular complications. This study aimed to compare serum homocysteine levels between TDT patients with regular and irregular folic acid supplementation and to assess correlations with duration of supplementation and age.

Methods This cross-sectional comparative study was conducted at the Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, between March 2023 and February 2024. Forty TDT patients were categorized into regular (n=20) and irregular (n=20) folic acid supplementation groups. Fasting serum homocysteine levels were measured using chemiluminescent immunoassay. Data were analyzed using SPSS version 27.0.

Results Mean serum homocysteine was significantly lower in the regular supplementation group (5.19±1.04 µmol/l) compared with the irregular group (13.68±5.47 µmol/l; p<0.001). Hyperhomocysteinemia (≥15 µmol/l) was observed exclusively among irregularly supplemented patients (30%). A negative correlation was identified between duration of supplementation and homocysteine level, while age showed a modest positive trend with homocysteine among irregular users.

Conclusions Irregular folic acid supplementation is associated with significantly elevated serum homocysteine levels in transfusion-dependent β-thalassemia patients. Sustained adherence to supplementation may reduce metabolic risk and should be emphasized in routine clinical management.