Acute effects of blood transfusion on pituitary gonadal axis and sperm parameters in adolescents and young men with thalassemia major: a pilot study

Abstract

Objective: To evaluate semen parameters and measure serum FSH, LH, T, and insulin-like growth factor (IGF) 1 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.

Patient(s): This study investigated 10 young adults with TM, aged 17-32 years, with full pubertal development (Tanner stage 5, eugonadal) and capacity to ejaculate. They had been regularly transfused since early childhood and underwent chelation therapy with the use of desferrioxamine replaced by deferasirox for the past 4-5 years. At the time of the study their serum ferritin levels ranged from 500 to 5,922 ng/mL (mean 2,686 ng/mL). Basal serum concentrations of FSH, LH, T, and IGF-1 were evaluated before and 7 days after PCTx.

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

Main outcome measure(s): After PCTx, a significant increase of hemoglobin from 8.7 ± 0.86 g/dL to 11.1 ± 0.82 g/dL was associated with increased T (from 16.5 ± 8 nmol/L to 20 ± 8.8 nmol/L), IGF-1 (from 173 ± 46 ng/mL to 214 ± 61 ng/mL), and gonadotropin concentrations.

Result(s): 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 and sperm volume and count. The increase of IGF-1 concentration was correlated significantly with hemoglobin level after PCTx and negatively with ferritin concentration. Significant correlations were found before and after PCTx between serum T concentrations and semen parameters, including sperm count, rapid progressive motility, and the number of sperm with normal morphology, and between IGF-1 levels and seminal parameters. No correlations were found between serum FSH and IGF-1 concentrations and seminal parameters.

Conclusion(s): 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. These "acute" effects on spermiogenesis are reached by an unknown mechanism and suggest a number of pathways that need further human and/or experimental studies.