Assessment of Pituitary Gonadal Axis and Sperm Parameters in Anemic Eugonadal Males Before and After Correction of Iron Deficiency Anemia.

ABSTRACT: :Iron deficiency anemia (IDA) is one of the most common nutritional anemia worldwide. Anemia imposes a significant hypoxic environment in different organs and tissues including the testes. This study evaluated the effect of treatment of IDA on the pituitary gonadal axis (Serum FSH, LH, Testosterone) and sperm parameters in adult eugonadal males. METHODOLOGY: A hospital based interventional, analytic study was conducted at a tertiary care center among 25 eugonadal males (fully sexually developed, fertile) with newly diagnosed and untreated IDA, admitted in medicine wards and not suffering from any inflammatory disorders (excluded by C-reactive protein) after exclusion of patients having other forms of anemia/ hemoglobinopathies/ any malignancy/having MCV >80 fL, aplastic anemia and primary hypogonadism. Sexual maturation was assessed according to maturity stages 5. Investigations were performed before and 6 weeks after treatment of IDA with intravenous iron sucrose included CBC, peripheral blood smear, serum ferritin, serum iron, TIBC, serum FSH, serum LH, serum Testosterone and semen analysis (Semen volume, Sperm count, Sperm motility and Sperm morphology). RESULTS: The change in mean Hb level before (5.66 ± 1.97gm/dl) and after treatment (11.96 ± 0.87 gm/dl) was statistically significant. (P<0.001) Patients who had subnormal and normal serum level of FSH, LH, Testosterone and sperm parameters before treatment were divided into group A and group B respectively. Serum levels of FSH, LH and testosterone along with sperm parameters significantly improved after correction of anemia (p<0.01). The mean change in these parameters was significantly higher in patients having subnormal value of these parameters before treatment (Group A) than in patients having normal pre-treatment level (Group B) (p<0.01). The level of anemia (hemoglobin) had significant positive correlation with serum FSH, serum LH, serum testosterone levels and sperm parameters (semen volume, sperm count, sperm morphology, RPM and sperm motility) (p<0.001). CONCLUSION: IDA had significant negative association with the pituitary gonadal axis (Serum FSH, LH, Testosterone) and sperm parameters in adult eugonadal males. The serum levels of FSH, LH and testosterone along with sperm parameters significantly improved after correction of anemia, especially in patients having subnormal value of these parameters.

Reticulocyte Hemoglobin Vis-À-Vis Immature Reticulocyte Fraction, as the earliest Indicator of Response to Therapy in Iron Deficiency Anemia.

AIM: To evaluate reticulocyte hemoglobin (RET-Hb) vis-à-vis immature reticulocyte fraction (IRF) as an earliest indicator of response to iron therapy in iron deficiency anemia (IDA), by assessing change in RET-He and IRF at 48 hours after initiation of intravenous iron therapy. MATERIAL AND METHODS: A hospital based interventional, analytic study was conducted among 144 patients (age group 15-65 years) with newly diagnosed and untreated IDA admitted in medicine ward and not suffering from any inflammatory disorders (excluded by C-reactive protein). Patient having other forms of anemia/hemoglobinopathies/ malignancy, MCV >80 fL and pregnant female were excluded. All patients were subjected to automated CBC, RET-He, iron studies and iron staining of bone marrow aspirates. Then intravenous iron sucrose was given along with oral antioxidants. After 48 hours, CBC, RET-He and IRF were repeated for each patient. RESULT: Total 144 patients were included. Of these, 42 patients were excluded due to aparticulate bone marrow aspirate. Remaining 102 patients were classified in to Group A (grade 0 and 1- depleted iron stores) and Group B (grade 2 and 3 - functional iron deficiency). RET-He and IRF increased significantly at 48 hours after initiation of intravenous iron therapy (post therapy) as compared to baseline (pre therapy) in both the two groups as well when all patients were considered together. Post therapy, the mean increase in RET-He was significantly smaller in magnitude in group B than in group A. The increase in IRF was not significantly different between the two groups. CONCLUSION: RET-Hb, a real time indicator of iron supply (hemoglobinization) to the developing RBC's, is the earliest marker of response to iron therapy as compared to IRF (representative of reticulocyte count).

Study of Association of Thyroid Hormone in Pre-Eclampsia and Normal Pregnancy.

AIM: The aim of the study was to assess association of thyroid hormone in preeclampsia and normal pregnancy. MATERIAL AND METHOD: This was a hospital based observational case control study. Total 100 women were included, out of them 50 normal pregnant women in control group and 50 pre-eclamptic women in case group were included. RESULT: In this study no significant difference was found in FT3 (p value 0.085) and FT4 (p value 0.065) in control and case group. TSH and Anti TPO levels in control and case group were statistically significant (p value <0.001 and <0.000). CONCLUSION: We observed that thyroid hormones (TSH and Anti TPO) have statistically significant relation in pre-eclamptic women.

Reticulocyte Hemoglobin vis-a-vis Serum Ferritin as a Marker of Bone Marrow Iron Store in Iron Deficiency Anemia.

AIM: To evaluate reticulocyte hemoglobin (RET-He) vis-a-vis serum ferritin as a marker of bone marrow iron store in iron deficiency anemia (IDA). MATERIAL AND METHODS: A hospital based analytic study was conducted among patients (age group 15-65 years) with newly diagnosed and untreated IDA admitted in medicine ward and not suffering from any inflammatory disorders (excluded by C-reactive protein). Patient having other forms of anemia/ hemoglobinopathies/ malignancy, MCV > 80 fL and pregnant female were excluded. All patients were subjected to automated CBC, RET-He, iron studies and iron staining of bone marrow aspirates. RESULTS: Total 142 patients were included. Of these, 42 patients were excluded due to aparticulate bone marrow aspirate. Remaining 102 patients were classified in to Group A (grade 0 and 1-depleted iron stores) and Group B (grade 2 and 3 - functional iron deficiency). There were significant difference in means of RET-He (Group A 17.84 ± 2.39 vs. Group B 25.08 ± 4.42; P< 0.0001) and serum ferritin (Group A 8.68 ± 2.80 vs. Group B 15.61 ± 4.68; P < 0.0001). We observed significant positive correlation of ferritin with RET-He in total patients (r = 0.7860, p 0.0000), Group A (r = 0.7089, p 0.00) and Group B (r = 0.4675, p < 0.05) patients. RET-He was the only significant predictor of bone marrow iron stores (at P < 0.05). On ROC curve analysis, the AUC for RET-He was found to be 0.894 (P value < 0.01) and best cut off value for predicting IDA was 22.4 pg (sensitivity 98.88%, specificity 84.21%). The AUC for serum ferritin was 0.891 (P value < 0.01) and best cut off value for predicting IDA was 11.6 ng/ml (sensitivity 86.75%, specificity 89.47 %). CONCLUSIONS: RET-He correlated significantly with serum ferritin and is also a better predictor of bone marrow iron stores than the latter.