Acute Effects of Blood transfusion on Pituitary Gonadal Axis and Sperm Parameters in Adolescents and Young Menwith Thalassemia Major: A Pilot Study

Capsule:
This study suggests that in thalassemic men, blood transfusion is associated with significant acute enhancement of sperm parameters and increased concentrations of serum T, LH, FSH, and IGF-1.

Authors:
Ashraf Soliman, M.D., Ph.D., F.R.C.P., Mohamed Yasin, M.B.B.S., C.A.B.M., M.Sc., F.A.C.P., Ahmed El-Awwa, M.D., Mohamed Osman, M.D., Ph.D., Vincenzo De Sanctis, M.D.

Volume 98, Issue 3, Pages 638-643, September 2012

Abstract:

Objective:
To evaluate semen parameters and measure serum follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T) and insulin-like growth factor-I ( IGF-I ) concentrations before and 7 days after packed red cell transfusion (PCTx) in young adults with thalassemia major (TM).

Design:
Prospective study.

Setting:
Tertiary care hospital

Patients:
This study investigated 10 young adults with TM, aged from 17 to 32 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. At the time of the study their serum ferritin levels ranged from 500 to 5922 ng/ml (mean2686 ng/ml). Basal serum concentrations of FSH, LH, T and IGF-I were evaluated before and 7 days after packed red cell transfusion (PCTx).

Interventions:
We studied the effect of PCTx on semen parameters and the endocrine functions in these 10
patients with TM.

Main Outcome Measures and Results:
After PCTx significant increase of Hb from 8.7 +/- 0.86 g/dl to 11.1 +/- 0.82 g/dl was associated with increased testosterone (from 16.5 +/- 8 nmol/L to 20 +/- 8.8 nmol/L, IGF-I (from 173 +/- 46ng/ml to 214 +/- 61ng/ml) and gonadotropins’ concentrations. Total sperm count increased significantly from 57.8 +/- 38.3 million/ml to 166 +/- 132 million/ml and rapid progressive sperm motility progressive motility increased from 20.6+/- 16.6 % to 79.7 +/- 67.4 %. After PCTx, LH concentrations were correlated significantly with T concentrations ( r = 0.434, p < 0.001) and sperm volume and count (r = 0.439 and r = 0.376 respectively , p: 0.01). The increase of IGF-I concentration was correlated significantly with Hb level after PCTx (r = 0.535, p < 0.001) and negatively with ferritin concentration (r = -0.458, p < 0.001). Significant correlation were found between serum T concentrations and semen parameters before and after PCTx including sperm count ( r = 0.658 and r = 0.73 respectively, p < 0.001)rapid progressive motility (r = 0.675 and r = 0.758 respectively p < 0.001), and the number of sperms with normal morphology (r = 0.752 and r = 0.834 respectively, p < 0.001) IGF-I levels and seminal parameters. No correlations were found between serum FSH and IGFI concentrations and seminal parameters.

Conclusion:
Our study suggests that in thalassemic males blood transfusion is associated with significant acute enhancement of sperm parameters and with an increased concentrations of serum testosterone, LH, FSH and IGF-I. 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.

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