Hepatitis C virus (HCV) infection remains a major global health challenge, particularly for children with hereditary hemoglobinopathies who require lifelong transfusion support. This retrospective, registry-based study examined all 1,140 patients aged 6–18 years with hemoglobinopathies registered at the Basra Center for Hereditary Blood Diseases between 1 January 2017 and 31 December 2021 to determine HCV prevalence and associated risk factors. Annual HCV seropositivity ranged from 9.12 % in 2017 to a peak of 10.78 % in 2019; screening volume was highest in 2019 (n = 408) and lowest in 2021 (n = 54). Sickle-cell disease (SCD) constituted the largest diagnostic category. In 2021 HCV rates were 5.55 % in SCD and 3.70 % in transfusion-dependent thalassemia (TDT). Across the five-year period, multivariable analysis demonstrated significant associations between HCV seropositivity and older age, TDT diagnosis, frequent transfusion (≥12 units /year), prior splenectomy and use of deferoxamine infusion pumps (all p < 0.05). No significant relationship was observed with gender, urban versus rural residence, or history of dental procedures. Although the center’s overall HCV prevalence remains higher than that reported for the Iraqi general population, it is comparable to figures from the same institution in 2013–2014 and lower than rates published by other hereditary-blood-disease centers in Iraq and neighboring countries. These findings suggest gradual improvement in transfusion safety and infection-control practices but underscore the ongoing vulnerability of transfusion-dependent children. Continued efforts to enhance donor-blood screening, enforce strict transfusion protocols and educate families about HCV transmission are recommended to further reduce infection risk. Routine virological monitoring and early antiviral therapy should also be incorporated into comprehensive care pathways for children with hemoglobinopathies in Basra.

Index Terms: Hepatitis C virus, hemoglobinopathy, thalassemia, sickle cell disease, blood transfusion