Hubungan Kadar Serum Ferritin terhadap Gangguan Fungsi Paru pada Anak Talasemia Bergantung Transfusi di Pelayanan Rawat Sehari Talasemia RS Adam Malik Medan

Abstract

Background: Transfusion-dependent thalassemia requires regular transfusions to maintain normal hemoglobin levels and reduce the risk of short- and long-term complications. The pathophysiological mechanisms of thalassemia include chronic anemia, ineffective erythropoiesis, and iron overload. Iron accumulation, particularly in vital organs such as the heart, liver, and lungs, can lead to organ damage, including impaired lung function. The purpose of this study was to determine the relationship between serum ferritin levels and impaired lung function in children with transfusion-dependent thalassemia in the day care service at H. Adam Malik General Hospital, Medan. Methods: This was an observational, analytical, cross-sectional study. The study was conducted at the Thalassemia Day Care Service at Adam Malik Hospital from May to June 2025. Inclusion criteria were pediatric thalassemia patients aged 8–17 years who received regular transfusions every 3 weeks in the Thalassemia Day Care Service at Adam Malik Hospital. Data on patient demographic characteristics and serum ferritin levels were obtained from patient medical records, while lung function was assessed using spirometry. The data were tested using univariate, bivariate, and multivariate analyses using statistical software. Results: Analysis using the Kruskal-Wallis test showed a significant difference in serum ferritin levels based on the category of pulmonary dysfunction (p < 0.001). Further post hoc testing using the Mann-Whitney test showed a significant difference in ferritin levels between normal and restrictive pulmonary function (p < 0.001) and normal and obstructive pulmonary function (p = 0.007). However, no significant difference was found between the restrictive and obstructive groups (p = 0.938). Multivariate analysis showed that serum ferritin levels significantly influenced the risk of developing pulmonary dysfunction, both restrictive (p = 0.003) and obstructive (p = 0.004). Each 1 ng/mL increase in ferritin levels increased the likelihood of experiencing restrictive and obstructive pulmonary function disorders by 0.2% (OR = 1.002; 95% CI: 1.001–1.003).

Latar Belakang: Talasemia bergantung transfusi merupakan talasemia yang memerlukan transfusi rutin untuk mempertahankan kadar hemoglobin normal dan menurunkan risiko komplikasi jangka pendek maupun jangka Panjang. Mekanisme patofisiologi pada talasemia mencakup terjadinya anemia kronis, eritropoiesis tidak efektif, dan kelebihan zat besi. Penumpukan zat besi terutama di organ-organ vital seperti jantung, hati, dan paru dapat menimbulkan kerusakan organ, termasuk gangguan fungsi paru. Tujuan penelitian ini mengetahui hubungan antara kadar serum ferritin dengan gangguan fungsi paru pada anak dengan talasemia yang bergantung transfusi di pelayanan rawat sehari RSUP H. Adam Malik Medan Metode: Penelitian ini merupakan studi observasional analitik dengan pendekatan cross-sectional. Penelitian dilaksanakan di Pelayanan Rawat Sehari Talasemia RS Adam Malik pada Bulan Mei-Juni 2025. Kriteria inklusi yaitu pasien anak talasemia yang berusia 8 – 17 tahun yang rutin transfusi setiap 3 minggu di Pelayanan Rawat Sehari Talasemia di RS Adam Malik. Data karakteristik demografi pasien dan kadar serum ferritin diperoleh dari rekam medis pasien, sedangkan fungsi paru dinilai melalui pemeriksaan spirometri. Data-data tersebut diuji dengan analisis univariat, bivariat, dan multivariat dengan menggunakan program statistik. Hasil: Analisis menggunakan uji Kruskal-Wallis menunjukkan bahwa terdapat perbedaan yang signifikan kadar serum ferritin berdasarkan kategori gangguan fungsi paru (p < 0,001). Uji lanjut (post hoc) menggunakan Mann-Whitney menunjukkan bahwa perbedaan kadar ferritin signifikan terjadi antara fungsi paru normal dan restriktif (p < 0,001) dengan fungsi paru normal dan obstruktif (p = 0,007). Namun, tidak ditemukan perbedaan signifikan antara kelompok restriktif vs obstruktif (p = 0,938). Analisis multivariat menunjukkan bahwa kadar serum ferritin berpengaruh signifikan terhadap risiko mengalami gangguan fungsi paru, baik tipe restriktif (p = 0,003) maupun obstruktif (p = 0,004). Setiap peningkatan kadar feritin sebesar 1 ng/mL meningkatkan kemungkinan mengalami gangguan fungsi paru tipe restriktif dan obstruktif sebesar 0,2% (OR = 1,002; 95% CI: 1,001–1,003).