INTRODUCTION: Pulmonary complications frequently occur as comorbidities in individuals with transfusion-dependent thalassaemia (TDT). Despite their clinical significance, the existing literature lacks a systematic review and meta-analysis examining the prevalence and risk factors for pulmonary dysfunction in this patient cohort. Therefore, we propose to conduct a systematic review and meta-analysis to report the prevalence and associated risk factors of pulmonary dysfunction in TDT patients. METHODS AND ANALYSIS: This systematic review and meta-analysis will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. We will search PubMed, EMBASE, the Cochrane Library, Scopus and Web of Science to identify English-language literature from the inception of each database up to 31 May 2024. We will include studies that involve TDT patients and report on the method of pulmonary function assessment, the proportion of pulmonary dysfunction and the analysis of risk factors for pulmonary dysfunction. The study designs included will be cohort, case-control and cross-sectional studies. Exclusions will apply to studies on non-TDT or patients with other diseases, reviews, case reports and animal experiments, as well as duplicated published studies, studies without full-text availability or studies from which raw data cannot be extracted. The screening process, including title, abstract and full texts, will be conducted independently by two reviewers. Data extraction will be performed following standardised protocols. The quality of the included studies will be assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality criteria. The meta-analysis will be conducted using Stata 14.0 and Review Manager (RevMan) 5.4 software, incorporating subgroup analyses, heterogeneity assessments and publication bias evaluations to ensure the robustness and reliability of the findings. ETHICS AND DISSEMINATION: As the data for this systematic review and meta-analysis are sourced exclusively from previously published literature, there is no requirement for ethical approval. The dissemination of the results will occur through publication in a peer-reviewed scholarly journal and presentations at relevant scientific conferences. PROSPERO REGISTRATION NUMBER: CRD42024504353.