title: Does blood transfusion affect pituitary gonadal axis and sperm parameters in young males with sickle cell disease?
abstract: OBJECTIVE
  We evaluated the effect of packed red cell transfusion (PCTx) on serum concentrations of gonadotropins luteinizing hormone and follicle-stimulating hormone (LH and FSH) and testosterone (T) levels and measured sperm parameters in young adults with sickle cell disease (SCD) on top-up transfusion (TTx) and those on exchange transfusion (ETx) regimen.
  
  
  METHODS
  Basal serum concentrations of FSH, LH, and T and semen parameters were evaluated before and 7 days after PCTx in 18 young adults with transfusion-dependent SCD, aged 20.7 ± 2.88 years. They had full pubertal development (Tanner's stage 5), and capacity to ejaculate. They were regularly transfused since early childhood. Chelation therapy was started early during the first 2 years of life using desferrioxamine and was replaced by deferasirox for the last 4-5 years. Ten patients were on TTx and eight were on ETx regimen.
  
  
  RESULTS
  PCTx significantly increased hemoglobin (Hb) from 8.5 ± 1.17 g/dl to 10.5 ± 0.4 g/dl, T from 12.3 ± 1.24 nmol/L to 14.23 ± 1.22 nmol/L and gonadotropins' concentrations. Sperm parameters improved significantly after PCTx including: total sperm count from 87.4 ± 24.6 million/ml to 146.2 ± 51.25 million/ml, total progressive sperm motility (TPM) from 40.8 ± 11.1 million/ml to 93.4 ± 38.3 million/ml, rapid progressive sperm motility (RPM) progressive motility from 29.26 ± 8.75 million/ml to 67.4 ± 29 million/ml. After PCTx the total sperm count, TPM and RPM were significantly better in the ETx group versus the TTx group. Before and after PCTx, 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). 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).
  
  
  CONCLUSIONS
  Our study suggests that in males with SCD blood transfusion is associated with significant acute enhancement of sperm parameters and with increased concentrations of serum T, LH, and FSH. Improvement of sperm parameters were significantly better in the ETx group verses the TTx group. These "acute" effects on spermiogenesis are reached with an unknown mechanism/s and suggest a number of pathways that need further human and/or experimental studies.
authors.affiliation: Department of Pediatric Endocrinology, Hamad Medical Center, Doha, Qatar.
authors.forename: Ashraf T
authors.initials: AT
authors.lastname: Soliman
authors.affiliation: Department of Hematology, Hamad Medical Center, Doha, Qatar.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Yasin
authors.affiliation: Department of Pediatric Endocrinology, Hamad Medical Center, Doha, Qatar.
authors.forename: Ahmed
authors.initials: A
authors.lastname: El-Awwa
authors.affiliation: Department of Clinical Chemistry, Hamad Medical Center, Doha, Qatar.
authors.forename: Mohamed O
authors.initials: MO
authors.lastname: Abdelrahman
authors.affiliation: Department of Pediatrics, Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: De Sanctis
keywords: Desferrioxamine; gonadotropins; sickle cell disease; spermatogenesis; testosterone