Acute Effects of Blood Transfusion On Pituitary Gonadal Axis and Sperm Parameters in Young Males with Sickle Cell Disease (SCD) Pilot Study

To evaluate semen parameters and measure serum follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (T) concentrations before and 7 days after packed red cell transfusion (PCTx) in young adults with sickle cell disease (SCD).

Prospective study.

This study investigated 18 young adults with transfusion – dependent SCD, aged 20.7 +/− 2.88 years, with full pubertal development (Tanner's stage 5) (euogonadal), and capacity to ejaculate. They were regularly transfused since early childhood and underwent chelation therapy using desferrioxamine which was replaced by deferasirox for the last 4–5 years. Ten were on top-up transfusion (TTx) and 8 were on exchange transfusion (ETx) regimen. At the time of the study their serum ferritin levels were 1488 +/− 557ng/ml. Basal serum concentrations of FSH, LH, T and IGF-I were evaluated before and 7 days after packed red cell transfusion (PCTx).

We studied the effect of PCTx on semen parameters and the endocrine functions in these 18 patients with SCD.

After Packed RBCs Transfusion(PCTx) significant increase of Hb from 8.5 +/− 1.17 g/dl to 10.5 +/− 0.4 g/dl was associated with increased testosterone (12.3 +/− 1.24 nmol/L to 14.23 +/− 1.22nmol/L and gonadotropins' concentrations.

Total sperm count increased significantly from 87.4 +/− 24.6 million/ml to 146.2 +/− 51.25 million/ml and total progressive sperm motility (TPM) from 40.8 +/− 11.1 million/ml to 93.4 +/− 38.3 million/ml, and rapid progressive sperm motility progressive motility (RPM) increased from 29.26 +/− 8.75 million/ml to 67.4 +/− 29 million/ml. After PCTx the total sperm count, TPM and RPM were significantly higher in the ETx group versus the TTx group.

Before and after PCTx, Testosterone (T) concentrations were correlated significantly with sperm total count, volume, TPM and RPM (r = 0.53, 0.55, 0.42 and 0.38 respectively, p: 0.01). Before and after PCTx, hemoglobin (Hb) concentrations were correlated significantly with Sperm count, TPM, RPM and % of sperms with normal morphology (r= 0.60, 0.69, 0.66 and 0.86 respectively, p < 0.001).

Our study suggests that in males with SCD blood transfusion is associated with significant acute enhancement of sperm parameters and with an increased concentration of serum testosterone, LH and FSH. Improvements of sperm parameters were significantly higher in the Exchange Transfusion group vs. the Top up Transfusion group. These “acute” effects on spermatogenesis are reached with an unknown mechanism/s and suggest a number of pathways that need further human and/or experimental studies.

Yassin:Hamad medical corporation MRC: Employment, Research Funding. Soliman:Hamad medical corporation MRC: Employment, Research Funding. Elawwa:Hamad medical corporation MRC: Consultancy, Research Funding.