Serum Homocysteine Level in Transfusion-Dependent Beta-Thalassemia Patients with Folic Acid Supplementation

Open Access

Abstract

Background: Transfusion-dependent beta-thalassemia (TDT) patients require lifelong transfusion therapy and supportive management. Folic acid supplementation is routinely prescribed to meet increased erythropoietic demands; however, its impact on serum homocysteine levels in this population remains inadequately characterized. Objectives:  To evaluate serum homocysteine levels in transfusion-dependent beta-thalassemia patients receiving folic acid supplementation. Methods & Materials: This cross-sectional study was conducted at the Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, from March 2023 to February 2024. Forty TDT patients aged >5 years receiving folic acid supplementation were enrolled. Demographic, nutritional and transfusion-related data were recorded. Fasting serum homocysteine was measured using chemiluminescent immunoassay. Statistical analysis was performed using SPSS version 27.0, with p≤0.05 considered significant. Results: The mean age of participants was 17.33 ± 9.13 years; 60% were male. Underweight status was observed in 70% of patients. Transfusion characteristics were comparable between supplementation groups. Patients receiving regular folic acid supplementation demonstrated significantly lower mean serum homocysteine levels (5.19 ± 1.04 µmol/L) compared with irregular users (13.68 ± 5.47 µmol/L; p<0.001). Hyperhomocysteinemia (≥15 µmol/L) was observed in 30% of irregularly supplemented patients but in none of the regularly supplemented patients. Conclusion: Regular folic acid supplementation is associated with maintenance of lower serum homocysteine levels in TDT patients. Sustained supplementation may play a role in mitigating vascular risk in this high-burden population.