Leg Ulcers in Thalassaemia: A Comparative Retrospective Review of Transfusion-Dependent and Non-Transfusion-Dependent Patients.

To compare clinical and laboratory characteristics of transfusion-dependent and non-transfusion-dependent beta thalassaemia patients with leg ulcers, and to identify contributing and protective factors We retrospectively reviewed 12 patients with beta thalassaemia and leg ulcers (seven transfusion-dependent and five non-transfusion-dependent) at a tertiary centre. We analysed demographics, haemoglobin levels, ferritin, foetal haemoglobin, transfusion status, comorbidities, and ulcer characteristics. Transfusion-dependent patients were predominantly younger males (mean age: 31.9 years), while non-transfusion-dependent patients were older (mean age: 44.0 years). Ulcers were larger in transfusion-dependent patients (mean area: 3.1 cm2) but more frequent in non-transfusion-dependent patients (mean episodes: 2.2). Splenectomy was performed in all transfusion-dependent patients and most non-transfusion-dependent patients. Transfusion-dependent patients had higher ferritin levels, while non-transfusion-dependent patients had higher foetal haemoglobin and slightly better ulcer resolution rates (80% vs. 71%). Major exacerbating factors included chronic anaemia, iron overload, trauma, and hypercoagulability. Protective factors included higher foetal haemoglobin levels, hydroxyurea use, occasional transfusions, and early conservative wound care. Although more commonly reported in non-transfusion-dependent patients, leg ulcers were also clinically significant in transfusion-dependent patients, where they were associated with larger ulcer size, higher iron burden, and incomplete healing despite regular transfusion and chelation. These findings highlight the need for heightened recognition and tailored preventive strategies for leg ulcers in transfusion-dependent thalassaemia.