Growth disorders are considered as one of the common complications of thalassemia major patients. The present study was conducted to examine the prevalence of short stature, underweight, and delayed puberty in patients with thalassemia major in Iran.
This review study was conducted based on systematic review and meta-analysis protocol (PRISMA) until 2017. To access relevant literature, two researchers independently searched Magiran, Medlib, Iranmedex, SID, PubMed, Scopus, ScienceDirect, Web of Science, as well as Google Scholar search engine. Pooled prevalence rates were calculated using a random effects model. Data were analyzed using Comprehensive Meta-Analysis Software (Version 2).
In 18 studies, including 2,446 Iranian thalassemia major patients, the prevalence of short stature was estimated to be 52.3% (95%CI: 45.7-58.8). The lowest prevalence of short stature was in the North of Iran (42.4% [95%CI: 34.7-50.4]) and Mazandaran province (31.8% [95%CI: 27.5-36.5]), and the highest prevalence was in the South (64.6% [95%CI: 51.2-72.1]) and Fars province (71.4% [95%CI: 49.8-86.3]). The prevalence of short stature among males and females was estimated to be 48.7% (95%CI: 39.3-58.1) and 40.4% (95%CI: 30.4-51.2), respectively, and male to female odds ratio was 1.21 (95%CI: 1.01-1.46, P=0.03). Prevalence of delayed puberty and underweight in Iranian thalassemia major patients were estimated to be 67.5% (95%CI: 46.8-83.1) and 47.6% (95%CI: 37.0-58.4), respectively.
The results of this meta-analysis showed that the prevalence of short stature, delayed puberty, and underweight in Iranian thalassemia major patients is very high. Therefore, new planning and policies seem necessary to minimize the complications in patients with thalassemia major

Background: Thalassemia major (TM) is one of the most common hereditary anemia with multiple endocrinopathies (especially hypogonadism). So, we evaluated the rate of delayed puberty (DP) and its relation with serum ferritin level in patients.
Materials and Methods: This cross-sectional (descriptive-analytical) study was conducted on 100 patients with TM between 14-64 years old, admitted to Amirkola Thalassemia Center, Babol, Iran, in 2016. The pubertal status, (Marshall-Tanner scale), existance of DP, and its different types were evaluated. Mean serum ferritin level was measured and the data were classified to three groups of <1500, 1500-2500, and >2500 ng/ml. Data were analyzed using SPSS (version20).
Results: Out of 100 patients, 64 (64%) and 36 (36%) were female and male, respectively. Considering age, 23, 77 patients (%) were under and over 20 years old, respectively. Totally, 69 (69%) of them had DP, of whom 64 (92.8%) ones had secondary (central) hypogonadotropic hypogonadism. Mean serum ferritin level (±SD) was 2707.94±1683.42 ng/ml. In addition, 26, 29, and 45 patients had ferritin level <1500, 1500-2500, and >2500 ng/ml, respectively. Thirty two patients with DP (46.4%) had ferritin level above 2500 ng/ml (p-value= 0.623).
Conclusion: The results showed a high frequency of DP in TM patients, requiring careful examination and follow-up in terms of puberty for early diagnosis and proper treatment to improve their quality of life, and prevention of the complications like osteoporosis. We couldn't find any significant relationship between serum ferritin level and hypogonadism, even for cases who received enough iron chelators.