Blood Transfusion Increases Hospital Acquired Septicaemia

Abstract Abstract 3346 The rate of septicaemia was measured following blood transfusion in patients admitted to hospital greater than 48 hours. The data was collected prospectively and analysed retrospectively. The aim of the analysis was to disprove that red cell transfusion increased the rate of hospital acquired septicaemia. Data was extracted on patients who had a transfusion and an episode of septicaemia between 1999 and 2008 at a university teaching hospital, John Hunter Hospital, Newcastle, Australia (JHH). The database contained information on 20161 transfusion events of 102,600 units of packed red cells. The septicaemia database contained 8375 patients with blood culture proven septicaemia. Blood was issued using a computerised cross matching system. Analysis of the issuing of blood found no bias in the age of blood issued based on age, sex, number of units or by year of issue. All patients having a septicaemic event recorded following transfusion were analysed and compared to septicaemia occurring in all admissions greater than 48hrs in which no transfusion occurred. All patients who were diagnosed with septicaemia in the 6 month prior to transfusion were excluded as were patients who received five or more units of packed red cells to exclude the bias from the sickest patients. All patients whose septicaemia occurred greater than 16 days after transfusion were excluded as were patients whose septicaemia occurred before the second day after transfusion. A total of 258 patients were reviewed to test the hypothesis. Table1. There was a statistically significant increase in septicaemia following red cell transfusion. The null hypothesis was rejected. The data base was examined by the age of red cells transfused and its effect on nosocomial septicaemia. There was a statistically significant effect of older blood on the rate of septicaemia. Packed red cells transfused less than 14 days of age had no effect on the septicaemia rate. Blood that was 14–28 days of age increased the rate of nosocomial septicaemia by 1.65. Red Cells that were between 29 and 35 days of age increased the rate of septicaemia by 2.5 times. Blood that was between 36 and 42 days of age increased the rate by approximately 4.4 times, with the absolute risk of developing septicaemia within 15 days being approximately 4%. Table2. The time course of septicaemia was examined for patients receiving at least one unit of 28 day old blood. It was found that the risk of sepsis lasted less than 15 days p<0.001. The conclusion of our analysis suggests that packed red cells older than 14 days increase the risk of septicaemia in hospitalised patients, this effect continues to rise until 42 days post collection. Table 1 N Odds Ratio (CI) Total cases of nosocomial septicaemia 1684 • Admissions greater than 48 hours 175,325 Prior to exclusions • All transfusions • No previous sepsis 790 10.2 (10.1–10.3) Study Group • Less than 5 units Transfusion. • No previous sepsis. • Septicaemia >2 days <16days 258 2.02 (1.92–2.12) Table 2 Age of oldest red cell pack Less than 15 days of age 15 to 28 days of age 29–35 days of age 36–42 days of age Percentage transfused 24% 49% 14% 12% Number of transfusions < 5 units 3524 7161 2115 1802 Septicaemia observed 33 102 52 71 Odds ratio 0.98 1.54 2.55 4.4 Confidence Interval. 0.65–1.31 1.34–1.74 2.26–2.84 4.16–4.64 Disclosures: No relevant conflicts of interest to declare.

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Expansion of Red Blood Cells for Transfusion

Blood ◽

10.1182/blood.v116.21.sci-46.sci-46 ◽

2010 ◽

Vol 116 (21) ◽

pp. SCI-46-SCI-46

Author(s):

Anna Rita F Migliaccio ◽

Carolyn Whitsett ◽

Giovanni Migliaccio

Keyword(s):

Stem Cells ◽

Blood Transfusion ◽

Blood Supply ◽

Ex Vivo ◽

Red Cells ◽

Blood Group Antigens ◽

Red Cell ◽

Erythroid Cells ◽

Red Cell Transfusion ◽

Safety Considerations

Abstract Abstract SCI-46 Blood transfusion, the earliest form of cell replacement therapy, has become indispensable for modern medicine making the safety and adequacy of the blood supply a national priority. The US blood supply is adequate overall because in 2006 the number of blood units collected exceed by 7.8% the number of those transfused. However, issues surrounding blood transfusion, such as sporadic shortages and potential adverse events to recipients (related to changes in red cell physiology during storage and alloimmunization in chronically transfused patients) prompted past and current efforts to develop alternative transfusion products. Recently, the culture conditions to generate erythroid cells have greatly improved making the production of a transfusion product ex-vivo a theoretically possible, although expensive, proposition. This recognition is inspiring several investigators to develop production processes for ex-vivo generation of red cell transfusion products. A proof-of-concept demonstrating that ex-vivo generated red cells protect mice from experimentally induced lethal anemia has been obtained. Alternative sources of stem cells which include human embryonic stem cells (hESC) and induced pluripotency stem cells (iPS), are being explored. Since red cells do not have a nucleus, safety considerations suggest that they may represent the first cell therapy product to be generated from hESC and iPS. In addition, discarded hematopoietic stem cells present in adult and cord blood donations may theoretically generate numbers of red cells ex-vivo sufficient for transfusion. Affordable clinical grade humanized culture media have also been developed. Possible differences in immunological and biological properties of erythroid cells from different sources are under investigation. These differences include size, levels of activity of glycolytic enzymes and carbonic anhydrase, expression of different isozymes, hemoglobin and antigenic profiles (HLA class II antigens). This last aspect is particularly important because ex-vivo expanded red cells pose the same risk for infection and incompatibility as any transfusion product but pose unique antigenic risks. Since expression of blood group antigens is susceptible to post-transcriptional modifications, the ex-vivo expansion process itself may induce antigenic variability. Therefore, even cells generated from completely matched stem cell sources may induce auto-immunity and/or appear incompatible. Regarding the identity of ex-vivo generated red cell transfusion products, a conservative approach would be to define them as “enucleated red cells”. In principle, however, ex-vivo generated erythroblasts may also serve as transfusion product. Since they undergo 4–64 further divisions and reduce iron overload, they may represent a more potent transfusion product for patients that require chronic transfusion. The clinical use of these cells, however, may involve development of specific procedures to facilitate their homing/maturation in the erythroid niches of the recipients. In summary, on the basis of these cost, logistic and safety considerations we hypothesize that the clinical application of ex-vivo expanded erythroblasts will involve in sequence, drug discovery for personalized therapy, systemic drug delivery, genotypically matched transfusion for alloimmunized patients and then transfusion in the general population. Disclosures: No relevant conflicts of interest to declare.

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Reduction in massive postpartum haemorrhage and red blood cell transfusion during a national quality improvement project, Obstetric Bleeding Strategy for Wales, OBS Cymru: an observational study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03853-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sarah F. Bell ◽

Rachel E. Collis ◽

Philip Pallmann ◽

Christopher Bailey ◽

Kathryn James ◽

...

Keyword(s):

Risk Assessment ◽

Quality Improvement ◽

Blood Loss ◽

Postpartum Haemorrhage ◽

Red Cells ◽

National Database ◽

Care Bundle ◽

Red Cell ◽

National Quality ◽

Red Cell Transfusion

Abstract Background Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality and its incidence is increasing in many countries despite management guidelines. A national quality improvement programme called the Obstetric Bleeding Strategy for Wales (OBS Cymru) was introduced in all obstetric units in Wales. The aim was to reduce moderate PPH (1000 mL) progressing to massive PPH (> 2500 mL) and the need for red cell transfusion. Methods A PPH care bundle was introduced into all 12 obstetric units in Wales included all women giving birth in 2017 and 2018 (n = 61,094). The care bundle prompted: universal risk assessment, quantitative measurement of blood loss after all deliveries (as opposed to visual estimation), structured escalation to senior clinicians and point-of-care viscoelastometric-guided early fibrinogen replacement. Data were submitted by each obstetric unit to a national database. Outcome measures were incidence of massive PPH (> 2500 mL) and red cell transfusion. Analysis was performed using linear regression of the all Wales monthly data. Results Uptake of the intervention was good: quantitative blood loss measurement and risk assessment increased to 98.1 and 64.5% of all PPH > 1000 mL, whilst ROTEM use for PPH > 1500 mL increased to 68.2%. Massive PPH decreased by 1.10 (95% CI 0.28 to 1.92) per 1000 maternities per year (P = 0.011). Fewer women progressed from moderate to massive PPH in the last 6 months, 74/1490 (5.0%), than in the first 6 months, 97/1386 (7.0%), (P = 0.021). Units of red cells transfused decreased by 7.4 (95% CI 1.6 to 13.2) per 1000 maternities per year (P = 0.015). Red cells were transfused to 350/15204 (2.3%) and 268/15150 (1.8%) (P = 0.001) in the first and last 6 months, respectively. There was no increase in the number of women with lowest haemoglobin below 80 g/L during this time period. Infusions of fresh frozen plasma fell and there was no increase in the number of women with haemostatic impairment. Conclusions The OBS Cymru care bundle was feasible to implement and associated with progressive, clinically significant improvements in outcomes for PPH across Wales. It is applicable across obstetric units of widely varying size, complexity and staff mixes.

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Developing a National Registry for Hemochromatosis

Improving Health Management through Clinical Decision Support Systems - Advances in Healthcare Information Systems and Administration ◽

10.4018/978-1-4666-9432-3.ch007 ◽

2016 ◽

pp. 154-164

Author(s):

Indu Singh ◽

Janelle Guerrero ◽

Michael J. Simmonds

Keyword(s):

Blood Transfusion ◽

Hereditary Hemochromatosis ◽

National Registry ◽

Red Cross ◽

Blood Collection ◽

Healthy Population ◽

Red Cell ◽

Blood Products ◽

Patient Health ◽

Red Cell Transfusion

Hereditary Hemochromatosis (HH) is a disorder where iron and ferritin concentrations in a patient's blood are much higher than normal healthy levels. The main therapeutic intervention for individuals with HH is removing 300-500 mL of blood every few months to maintain ferritin concentration within acceptable ranges. The blood collected during these venesections is usually discarded as there is a belief that blood with high levels of ferritin are not suitable for blood transfusion purposes. Australian Red Cross Blood Services voluntarily collects blood from donors for subsequent use in blood transfusion. Annually more than 700 thousand units are transfused within Australia and there is a constant need for new donors given the significant imbalance between supply and demand of blood products. Besides red cell transfusions, the Red Cross also issues donor blood for development of many other blood products essential for patient health care. The HH blood can currently be used for other blood products if not for red cell transfusion. However, there is evidence to suggest that there is no significant difference between the red cells of the normal healthy population compared to those from HH patients. Australian Red Cross has developed a mobile computer application (High Ferritin “app”) as they have started collecting blood from HH patients. Though there is little or no awareness about the existence and use of this High Ferritin app in general HH population, their doctors and nurses collecting their blood for therapeutic purposes. This chapter describes possibility of saving and utilizing the blood collected from hemochromatosis patients for therapeutic purposes. A national hemochromatosis patients registry, in collaboration with High Ferritin app (HFa) developed by Australian Red Cross Blood Services, accessible to the patients, their doctors and Red Cross Blood Collection Sservices 24 hours a day anywhere in the country can allow the patients to donate the blood collected for therapeutic purposes at any affiliated blood collection center in the country after they automatically get a message either by email or text message after their blood results have been reviewed by their doctor and they are required to go for venesection.

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An Unusual Case of ‘Delayed‘ Febrile Non Hemolytic Transfusion Reaction in a Thalassemia Major Patient with Asymptomatic Plasmodium Falciparum Infection.

Blood ◽

10.1182/blood.v114.22.4186.4186 ◽

2009 ◽

Vol 114 (22) ◽

pp. 4186-4186

Author(s):

Carla Boschetti ◽

Franca Radaelli ◽

Mariangela Colombi ◽

Cristina Vercellati ◽

Luisa Caspani ◽

...

Keyword(s):

Blood Smear ◽

Conflicts Of Interest ◽

Falciparum Infection ◽

Red Cells ◽

Cell Counting ◽

Dramatic Improvement ◽

Asymptomatic Malaria ◽

Red Cell ◽

Transfusion Reaction ◽

Clinical Conditions

Abstract Abstract 4186 We report the case of a thalassemic patient with asymptomatic malaria in which the infection became clinically manifest only after blood transfusion, mimicking a febrile non haemolytic transfusion reaction. The patient was a 19 yr old thalassemic girl from Togo regularly and uneventfully transfused every 60-90 days since the age of 5 months and splenectomised at 13 yrs. Two malaria episodes in 1995 and 1997 were treated with quinine and halofantrin respectively. In February 2008 the transfusion interval shortened (15 days) and blood transfusions were constantly followed after 30-40 hours by high fever (39-4028C) and hypotension. The patient was referred to our Hospital to clarify and overcome the transfusion problems. Malaria attacks were excluded by the referring clinic. At admission, Hb was 5.9 g/dL, Hct 18.3%, MCV 71.8 fL, MCH 23.1 pg, MCHC 32.2%, reticulocytes 0.82%. WBC 13.1 × 109/L platelet count 953 × 109/L erythroblasts 12.7% of nucleated cells. Molecular analysis of β and α genes revealed double heterozygosity for β IVS1-1 G>A and β IVS2-849 A>G, associated with deletion 3.7 (-α3.7) at the heterozygous state. G6PD 6.29 IU/g Hb (ref.values 5.97±1), Pyruvate kinase 25.1 IU/gHb (ref. v. 11.9-16.1). Red cell osmotic fragility was decreased. The cytofluorimetric analysis of red cells labelled with eosin 5 maleimide gave normal results. Direct antiglobulin test was negative and red cell alloantibodies were not detected. The patient's blood group assessed by molecular biology testing was: genotype O1A2, phenotype A2; ccDee; K-k+; Jk(a+b-); Fy(a-b+); M+N+S+s-. The patient was given 2 crossmatch negative, filtered O neg units: the post-transfusion Hb values were 9.9 g/dL. Thirty-two hours later the patient developed fever (40°C) and hypotension followed by disseminated intravascular coagulation, metabolic acidosis and anuria. Direct and indirect antiglobulin tests were negative on a post-transfusion sample. Because of the rapid worsening of clinical conditions she was admitted to the Intensive Care Unit of our Hospital. Septic shock was excluded on the basis of negative blood cultures and infectious diseases testing. Microscopic examination of thick blood smear was negative for malaria parasites on 2 consecutive days and the malaria rapid diagnostic test (RDT) (Core Malaria Pan-PV-PF®, Core Diagnostics, U.K.-Effegiemme, Nerviano, Milano, Italy) gave inconsistent results. Anti Plasmodium total antibodies (Malaria EIA New Market Laboratories U.K.- Bio-Rad Italia) were detected in the serum at high levels (odd sample/cut off 22). Vital functions were supported by mechanical ventilation, amine administration and continuous venous-venous hemofiltration (CVVH). Broad spectrum antibiotic therapy was started. Fresh frozen plasma and two units of PRC were transfused on day 1 and 2 without increment of Hb level. Three days later, the examination of the peripheral blood smear for counting schistocytes revealed the presence of parasites in a very small number of red cells. This finding was almost simultaneous to the availability of PCR testing results that were positive for P. Falciparum. The differential agglutination with anti A antibody performed on a blood sample collected at admission to ICU allowed to separate patient's and donors' red cell. Counting the number of parasitized red cells in total blood and in the donor fraction blood revealed that the parasitized cells were almost exclusively those of donors (14.4 % vs 0.029%). Treatment with quinine chlorhydrate 500 mg i.v. every 8 hr for 3 days followed by oral quinine sulphate 500 mg every 8 hr for 3 days was successfully undertaken without significant side effects leading to dramatic improvement of clinical conditions and to eradication of P. falciparum. Two RBC units were effectively transfused without any reaction, and in the following two weeks the patient maintained stable haemoglobin values. After discharge, the transfusion interval returned to the previous values (60-90 days) without any post-transfusion reaction. We therefore think that the transfusion of normal, non malaria-resistant red cells fuelled the P. falciparum infection causing fever, DIC and acidosis giving rise to a very severe, atypical febrile non haemolytic transfusion related reaction. Disclosures: No relevant conflicts of interest to declare.

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From Hematopoietic Stem Cell to Erythroblast: Regulation of Red Cell Production At Multiple Levels

Blood ◽

10.1182/blood.v118.21.sci-1.sci-1 ◽

2011 ◽

Vol 118 (21) ◽

pp. SCI-1-SCI-1 ◽

Cited By ~ 3

Author(s):

Harvey F. Lodish

Keyword(s):

Conflicts Of Interest ◽

Inflammatory Diseases ◽

Stress Hormones ◽

Red Cells ◽

Red Cell ◽

Short Term ◽

Self Renewal ◽

Hematopoietic Stem ◽

Cell Production ◽

Multiple Levels

Abstract SCI-1 Hematopoietic stem cells (HSC) undergo self-renewal and also generate all types of blood cells, including red cells, myeloid cells, and all immune system cells. Formation of red cells from HSC involves multiple cellular stages, including early erythroid-specific progenitors (burst-forming unit-erythroid [BFU-E]) that respond to several growth factors and an erythropoietin (Epo)-responsive progenitor, and the colony-forming unit-erythroid (CFU-E) that in 3 days generates ∼30 reticulocytes. In adult animals most CFU-E cells undergo apoptosis. A short-term need for red cells is met by increased Epo production by the kidney, which rescues increasing numbers of CFU-Es from apoptosis and increases red cell production over a few days. Chronic stress, such as in certain types of anemias and inflammatory diseases, leads to a marked increase in numbers of HSC and many types of progenitor cells. I will focus most of my talk on stress-triggered BFU-E proliferation and formation of CFU-Es, since our very recent work showed how glucocorticoids – an important class of stress hormones – as well as HIF-1α stimulate red cell production. Acting synergistically these allow ∼300 times more CFU-Es and erythroblasts to be formed from each BFU-E. More specifically, these molecules stimulate limited self-renewal of BFU-Es during cell division, thus maintaining progenitor immaturity and allowing over time increased numbers of CFU-E cells and thus mature red cells to be formed. This explains why certain corticosteroids are useful in treating some non-Epo responsive anemias, and I will present a molecular dissection of glucocorticoid and HIF-1α action on BFU-E progenitors that has led to the identification of genes critical for self-renewal and that suggest other possible avenues for treatment of chronic anemias. Disclosures: No relevant conflicts of interest to declare.

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Respiratory Impairment after Early Red Cell Transfusion in Pediatric Patients with ALI/ARDS

Critical Care Research and Practice ◽

10.1155/2012/646473 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6

Author(s):

Surender Rajasekaran ◽

Dominic Sanfilippo ◽

Allen Shoemaker ◽

Scott Curtis ◽

Sandra Zuiderveen ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Acute Lung Injury ◽

Blood Cell ◽

Odds Ratio ◽

Pediatric Patients ◽

Distress Syndrome ◽

Red Cell ◽

Respiratory Impairment ◽

Red Cell Transfusion

Introduction. In the first 48 hours of ventilating patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), a multipronged approach including packed red blood cell (PRBC) transfusion is undertaken to maintain oxygen delivery.Hypothesis. We hypothesized children with ALI/ARDS transfused within 48 hours of initiating mechanical ventilation would have worse outcome. The course of 34 transfused patients was retrospectively compared to 45 nontransfused control patients admitted to the PICU at Helen DeVos Children’s Hospital between January 1st 2008 and December 31st 2009.Results. Mean hemoglobin (Hb) prior to transfusion was 8.2 g/dl compared to 10.1 g/dl in control. P/F ratio decreased from135.4±7.5to116.5±8.8in transfused but increased from148.0±8.0to190.4±17.8(P<0.001) in control. OI increased in the transfused from11.7±0.9to18.7±1.6but not in control. Ventilator days in the transfused were15.6±1.7versus9.5±0.6days in control (P<0.001). There was a trend towards higher rates of MODS in transfused patients; 29.4% versus 17.7%, odds ratio 1.92, 95% CI; 0.6–5.6 Fisher exactP<0.282.Conclusion. This study suggests that early transfusions of patients with ALI/ARDS were associated with increased ventilatory needs.

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Packed red cell blood transfusion practices review in medical oncology unit in a tertiary cancer center, South India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195187 ◽

2019 ◽

Vol 7 (12) ◽

pp. 4433

Author(s):

Veerendra Angadi ◽

Manjunath Nandennavar ◽

Shashidhar V. Karpurmath ◽

Roshan Jacob ◽

Yamini Donekal

Keyword(s):

Blood Transfusion ◽

Cancer Patients ◽

Intravenous Iron ◽

Red Blood Cell Transfusion ◽

Cancer Center ◽

Red Cell ◽

Retrospective Case ◽

Case Record ◽

Red Cell Transfusion ◽

Oncology Unit

Background: Anaemia is a very common complication in cancer patients. Up to 60% of solid tumor patients and 70-90% of patients receiving myelosuppressive chemotherapy have anaemia. Pathophysiology of anaemia in cancer patients is multifactorial. The treatments for cancer related anaemia include Erythropoietin Stimulating Agents (ESAs), iron supplementing therapies (intravenous iron, oral iron) and blood transfusion. There are various safety concerns regarding usage of ESAs; also, their usage is less in India due to cost factor. There is scant literature regarding blood transfusion practices in patients undergoing chemotherapy.Methods: Patients diagnosed with cancer and patients receiving chemotherapy were included in the study. Retrospective case record review of cancer patients who received chemotherapy between January to March 2019 was done. Type of malignancy, presence of symptoms related to anemia and trigger for packed red cell transfusion were recorded.Results: Among 342 patients received total of 1365 cycles of chemotherapy in this time period. Mean age of patients was 46 years. 46 of the 342 patients received blood transfusion. Only 13% of the patients had symptoms of anemia like weakness and fatigue the average hemoglobin level at which transfusion was given was 6 gm/dL.Conclusions: Packed Red blood cell transfusion was usually administered at Hb <7 gm/dL. Very few patients reported anaemia related symptoms prior to transfusion. No patient received erythropoietin. Further data is needed from other tertiary cancer centres to understand the blood transfusion practices in Indian cancer patients undergoing chemotherapy.

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Anticoagulation, bleeding and blood transfusion practices in Australasian cardiac surgical practice

Anaesthesia and Intensive Care ◽

10.1177/0310057x0703500516 ◽

2007 ◽

Vol 35 (5) ◽

pp. 760-768 ◽

Cited By ~ 13

Author(s):

D. J. Daly ◽

P. S. Myles ◽

J. A. Smith ◽

J. L. Knight ◽

O. Clavisi ◽

...

Keyword(s):

Blood Transfusion ◽

Teaching Hospitals ◽

Red Cell ◽

Transfusion Threshold ◽

Excessive Bleeding ◽

Factors Associated ◽

Antifibrinolytic Therapy ◽

Marked Variability ◽

Clopidogrel Therapy ◽

Red Cell Transfusion

We surveyed contemporary Australasian cardiac surgical and anaesthetic practice, focusing on antiplatelet and antifibrinolytic therapies and blood transfusion practices. The cohort included 499 sequential adult cardiac surgical patients in 12 Australasian teaching hospitals. A total of 282 (57%) patients received red cell or component transfusion. The median (IQR) red cell transfusion threshold haemogloblin levels were 66 (61-73) g/l intraoperative^ and 79 (74-85) g/l postoperatively. Many (40%) patients had aspirin within five days of surgery but this was not associated with blood loss or transfusion; 15% had Clopidogrel within seven days of surgery. In all, 30 patients (6%) required surgical re-exploration for bleeding. Factors associated with transfusion and excessive bleeding include pre-existing renal impairment, preoperative Clopidogrel therapy, and complex or emergency surgery. Despite frequent (67%) use of antifibrinolytic therapy, there was a marked variability in red cell transfusion rates between centres (range 17 to 79%, P <0.001). This suggests opportunities for improvement in implementation of guidelines and effective blood-sparing interventions. Many patients presenting for surgery receive antiplatelet and/or antifibrinolytic therapy, yet the subsequent benefits and risks remain unclear.

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Acute Effects of Blood Transfusion on Spermatogenesis and Pituitary Gonadal axis in Eugonadal Males with Beta Thalassemia Major (pilot study)

Blood ◽

10.1182/blood.v120.21.1027.1027 ◽

2012 ◽

Vol 120 (21) ◽

pp. 1027-1027

Author(s):

Mohamed A. Yassin ◽

Ashraf T Soliman ◽

Ahmed S Elawa ◽

Hanadi Rafii El-Ayoubi ◽

Vincenzo Desanctis

Keyword(s):

Blood Transfusion ◽

Research Funding ◽

Sperm Count ◽

Thalassemia Major ◽

Semen Parameters ◽

Red Cell ◽

Acute Effects ◽

Seminal Parameters ◽

Igf I ◽

Red Cell Transfusion

Abstract Abstract 1027 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, Patients, Interventions: We studied the effect of blood transfusion on semen parameters, the endocrine functions in 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). 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 IGF-I 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. Disclosures: Yassin: Hamad medical corporation MRC: Employment, Research Funding. Soliman:Hamad medical corporation MRC: Employment, Research Funding. Elawa:Hamad medical corporation MRC: Employment, Research Funding.

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