Evaluation of Serum Erythropoietin, Ferritin, Calcium, Magnesium, and Inorganic Phosphorus Levels in β-Thalassemia Patients

Abstract

Background: Beta-thalassemia is a common inherited chronic blood disorder characterized by defective β-globin synthesis, leading to chronic anemia and complications related to iron overload. Erythropoietin (EPO), ferritin, calcium, magnesium, and inorganic phosphorus are important biomarkers that may reflect disease severity and metabolic alterations in these patients. Aim: This study aimed to evaluate and compare serum levels of Erythropoietin (EPO), Ferritin, Calcium, Magnesium, and Inorganic Phosphorus between β-thalassemia patients and healthy controls. Methodology: This cross-sectional study included 70 patients diagnosed with beta-thalassemia, recruited from the Oncology and Hematology Center at Tikrit Teaching Hospital and the Thalassemia, Hematology, and Genetic Diseases Center in Sulamaniyah. Patients were classified according to clinical severity into 30 with beta-thalassemia major, 20 with beta-thalassemia intermedia, and 20 with beta-thalassemia minor. In addition, 20 apparently healthy individuals were enrolled as a control group. Blood samples were collected between September 2025 and December 2025. The study population comprised 41 females and 49 males, with ages ranging from 2 to 25 years. Results: Erythropoietin levels showed significant elevation in β-thalassemia minor (245.3 ± 48.3 mIU/mL) compared to controls (183.6 ± 4.9 mIU/mL) (p=0.003). Ferritin levels exhibited marked elevation in β-thalassemia intermedia (875.3 ± 722.7 ng/mL) and β-thalassemia major (1723.1 ± 585.3 ng/mL) compared to controls (92.7 ± 37.7 ng/mL) (p<0.001). Mineral homeostasis analysis showed selective alterations in β-thalassemia patients compared to controls. First, magnesium levels remained unchanged across all groups (p=0.591). In contrast, inorganic phosphorus levels were significantly elevated in all β-thalassemia groups (6.0 ± 2.0 mg/dL in β-thalassemia minor, 6.4 ± 2.2 mg/dL in β-thalassemia intermedia, and 6.3 ± 1.8 mg/dL in β-thalassemia major) compared to controls (4.1 ± 0.4 mg/dL) (p<0.001). Calcium levels showed no significant changes across all groups (p=0.485). Conclusions: β-thalassemia patients exhibit marked increases in EPO, ferritin, and inorganic phosphorus, while calcium and magnesium remain stable. These findings highlight the importance of monitoring hematologic and mineral biomarkers to assess disease impact and guide management strategies.