#sickle cell disease (SCD)

[calvincell]

As a lifelong sufferer of sickle cell with co-morbidities (like arthritis & avascular necrosis) that quadruple my experiences with chronic pain, I couldn’t agree more. My sickle cell has caused me to have to go through two hip replacements & daily chronic pain in my back caused by similar deterioration of the bones in my spine. I’m 34 now but with each day comes the dread of how much more pain I might be in in my future & if I’ll be strong enough to tolerate it.

For nearly a decade now it’s gotten bad enough that I’ve gotten closer & closer to applying for disability as well as frequently contemplating a peaceful conclusion just to not have to deal with the pain anymore. I cannot work, shop, game, read, date, exercise, cook, travel or even really get out of bed without my meds & it is not at all due to addiction but the chronic pain which renders a basic daily routine torturous. I already despise spending time in the ER, doctors offices & hospital rooms but it’s made all the worse when I have to encounter & explain myself to medical professionals who don’t know my pain & the extent of its damage to my life. I have to deal with sympathy & suspicion in equal measure, always wondering if I’ll get someone who thinks I’m an addict or someone offers meds that haven’t helped in all my 30+ years or who is handicapped by their fear of being hounded by the DEA on my account. It’s an exhausting & soul-crushing way to live.

I understand the scope & damage of the opioid crisis & grieve for the victims & loved ones ravaged by it. I just also know what it is like to live trapped in a body that is so against you that it keeps you from baseline content living and/or makes you wonder if living is worth it. The amount of people living in that exact space, visibly or invisibility, is more staggering than a lot of people truly understand IMO. The form & scale of our nation’s harsh & militaristic drug criminalization absolutely doesn’t help in the way it should for either addicts or pain survivors alike & it’s a lesson we should have already learned as a country.

It is actually way better for 100 addicts to get their fix on pain pills than a single person in pain go without. I call this the "Torture is bad" principle. You should be able to get the good stuff forever after a single doctor's visit. If you're worried about addicts fund rehab centers and needle exchanges instead of torturing people.

[jcrmhscasereports]

Hydroxyurea and Sperm Abnormalities in Patients with Sickle Cell Disease by Dr. Salma M. AlDallal in Journal of Clinical Case Reports Medical Images and Health Sciences

ABSTRACT

Hydroxyurea is a key treatment option for patients having sickle cell disease. Although the treatment has been effective in improving the survival rate, new concerns over improving quality of life are forthcoming due to spermatogenesis-related toxicities and teratogenic effects. The available evidence shows that hydroxyurea might exacerbate the existing sperm abnormalities. There is a lack of comprehensive, systemic evidence to demonstrate the precise effects and role of hydroxyurea on sperm abnormalities in patients with sickle cell disease. Patients and healthcare providers require accurate and extensive information on sperm-related toxicities to make informed decisions. Here, I discuss the effects of hydroxyurea (HU) on sperm parameters, clinical study evidence, and treatment options available for fertility preservation in these patients.

Keywords: Sickle cell disease, Hydroxyurea, Sperm abnormalities

INTRODUCTION

Sickle cell disease (SCD) is a group of genetic blood disorders that leads to abnormality in hemoglobin. In patients with SCD, newer medical treatments have improved survival rates and quality of life along with a reduced disease-related morbidity. Consequently, the focus of the treatment is diverging to encompass the reproductive issues associated with these treatments. In adolescents and young patients with SCD, sexual maturation is delayed by 1.5-2 years [1, 2], and approximately 24% of SCD patients may have hypogonadism, infertility, erectile dysfunction, and poor libido [3]. The issues related to fertility and reproductive organs in SCD are either related to disease or to the treatments used to treat SCD-related morbidity.

Reduced SCD-related morbidity has been observed with treatments like hydroxyurea (HU) and hematopoietic stem cell transplantation (HSCT). However, adverse effects and toxicities associated with these therapies are a concern. HU use has been associated with sperm abnormalities and teratogenic effects [4, 5]. However, HU affects rapidly dividing cells, raising concerns about related toxicities. Therefore, it is essential to evaluate if there is an exacerbation of fertility problems in men with SCD. This review summarizes the spermatogenic effects of HU in males with SCD.

FERTILITY ISSUES IN MALES WITH SCD

Some of the disease-related fertility issues observed in patients with SCD are hypogonadism, sperm abnormalities, erectile dysfunction, delay in sexual maturation, and abnormal hormone (testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH)) levels.

The sperm abnormality rate is as high as 91% in males with SCD [6]. Although some reports attribute sperm abnormalities to delayed puberty in males with SCD [7], some others attribute it to testicular infarction or hypogonadism. It is also worth noting that sperm abnormalities also exist with normal testosterone, FSH, and LH levels [8].

In addition to sperm abnormalities, the incidence of erectile dysfunction in men with SCD is reported to be 21%–35% [9-11]. Also, a decrease in semen is reported in men with SCD [12]. Laboratory findings show low testosterone levels with variable FSH and LH levels. Moreover, abnormalities in accessory organs like seminal vesicles and prostate glands may be present due to recurrent urinary tract infections. These reproductive issues are exacerbated by therapies like HU, which have therapeutic effects through impairing DNA synthesis.

HU IN TREATMENT OF SCD

HU is approved for the prevention of vaso-occlusive pain in SCD. HU is a ribonucleotide reductase inhibitor that impairs DNA synthesis due to its S-phase-specific cytotoxic action. It is an antimitotic agent that can impair human spermatogenesis. It is a disease-modifying therapy that decreases episodes of acute pain and acute chest syndrome in SCD patients [13]. The HU therapy increases the fetal haemoglobin, which does not sickle under low oxygen tension. Low-dose HU therapy (10 mg/kg/day) has been effective in improving clinical and hematological parameters, reducing painful crises, and reducing blood transfusion requirements in SCD patients. Although HU has improved the quality of life and survival rate, its use is limited by its toxicities, particularly its effect on fertility parameters.

SCD itself manifests in some abnormalities like spermatogenesis, and seminal fluid, which may be exacerbated with cytotoxic HU therapy. HU is associated with abnormal sperm morphology [14] and a decrease in sperm count [14-16] in patients with SCD. At a therapeutic dose, it has short-lived, irregular cytotoxic effects on dividing cells [4]. Since it is an antimetabolite, it is hypothesized to have a risk of affecting sperm development [4]. These effects are often brief and reversible with discontinuation of the drug administration.

INFERTILITY IN MEN WITH SCD

Although HU treatment has improved outcomes in patients with SCD, it has been associated with effects on spermatogenesis and teratogenicity, for example, testicular atrophy, hypogonadism, decreased sperm count, abnormal sperm motility, and abnormal sperm morphology.

HYPOGONADISM

Male hypogonadism is decreased functional activity of the gonads that results in a testosterone deficiency. Testosterone deficiency can cause infertility, muscle wasting, and the absence of secondary sex characteristics. The mechanism for the cause of hypogonadism may be primary gonadal failure [17-19], repeated testicular infarction [20], zinc deficiency [21, 22], and partial hypothalamic hypogonadism [23].

ABNORMAL SPERMATOGENESIS

Impaired spermatogenesis has been reported in male patients with SCD receiving HU therapy, which leads to testicular atrophy, oligozoospermia (low sperm count), abnormal sperm morphology, and azoospermia (decreased sperm motility) [6, 15, 16, 24-31]. It is yet unclear if the abnormalities directly affect HU therapy. However, some researchers believe that the extent of sperm abnormalities might be associated with the length of HU therapy [29, 30]. Since SCD is a genetic condition manifesting at an early age, the duration of HU therapy remains long.

ABNORMAL HORMONE LEVEL

A few studies have reported altered levels of testosterone and dihydrotestosterone, FSH, and LH in patients with SCD [12, 32, 33]. The testosterone levels have a direct effect on fertility [6], reduction in semen volume, sperm count, and motility in sickle cell male patients [10].

PRIAPISM

Priapism is defined as a prolonged and lasting continued penile erection unrelated to sexual interest or stimulation [34]. The prevalence of priapism and erectile dysfunction in patients with SCD is 45% and 30%, respectively [35-37].

Penile erection is regulated by the neurotransmitter nitric oxide (NO). In SCD patients, the bioavailability of NO is decreased, disturbing the relaxation of penile smooth muscle [38, 39]. Also, the adenosine regulation pathway might be contributing to the pathophysiology of priapism in SCD patients.

STUDIES EVALUATING THE EFFECT OF HU THERAPY ON SPERMATOGENESIS SCD PATIENTS

Several studies have reported the role of HU in the exacerbation of various sperm abnormalities in patients with SCD. A non-interventional study (ESCORT-HU-European Sickle Cell Disease Cohort-Hydroxyurea) evaluated safety, morbidity, and mortality in 422 SCD patients of age 15years and older treated with HU [40, 41]. The study reported 67 pre-treatment and 24 during treatment semen analyses. Before treatment with HU, 49% of sperm analyses were normal, and 25% were abnormal (at least 1 abnormality: sperm mobility, sperm count, appearance). The rate of abnormalities during HU treatment increased to 50%. The abnormalities observed were asthenospermia, hypospermia, oligospermia, azoospermia, and atypical forms. These results confirmed that sperm abnormalities are exacerbated after HU treatment.

A prospective, Phase 4 multicentre study called HYDREP (NCT01609192) assessed the effect of HU treatment in patients with SCD [42]. The study reported a significant and rapid decrease in mean total sperm count from 129.8 million at baseline to 24.1 million at month 6. Furthermore, 86% of patients had an abnormal value of total sperm count at month 6 compared to only 40% at baseline. Researchers also found that 6 months of HU treatment did not affect the semen volume. They reported that the treatment of SCD with HU causes significant abnormality in spermatogenesis. After treatment, the number of men with abnormal total sperm count and cryptozoospermia increased to 30 patients and 5 patients, respectively. Additionally, six patients (17%) became azoospermic, and 19 were oligozoospermic.

An unmatched case-control study in Nigeria compared serum testosterone concentration among 47 patients with hemoglobin phenotype SS and 28 volunteers with hemoglobin phenotype AA [43]. The concentrations of serum testosterone in 44 of 47 hemoglobin phenotype SS patients were significantly lower as compared to 7 of 28 volunteers with hemoglobin phenotype AA.

A group of researchers evaluated the effect of long-term HU treatment from childhood to adult age in four patients [44]. These patients were receiving HU treatment for more than 8 years. They observed that two patients experienced severe oligozoospermia and two azoospermia. The treatment exposure in patients experiencing oligozoospermia was shorter (8 and 9 years) compared to patients experiencing azoospermia (12 and 15 years). There was also an increased percentage of abnormal spermatozoa morphology in these patients.

Furthermore, a study assessed spermatogonial quantity in prepubertal patients who received alkylating agents to compare with patients who received non-alkylating agents. They demonstrated that the quantity of spermatogonia per transverse tubular cross-section was significantly low in patients with SCD receiving hydroxyurea (0.3 ± 0.6, n = 6; P = 0.008) [45].Contrarily, a recent study reported no difference in semen volume, sperm concentration, total sperm count, or spermatozoa motility, morphology, and vitality between patients with SCD who received HU before puberty and who did not receive HU during puberty [46].

SEMEN ANALYSIS

A significant reduction in sperm density, ejaculate volume, sperm motility was reported in the SCD patients compared to the control subjects [43]. Likewise, some former studies that performed semen analysis in men with SCA reported a reduction in sperm motility, sperm density, and sperm morphology [44]. Similarly, Osegbe et al. and Agbaraji et al. analyzed sperm density, motility, morphology, and semen volume in patients with SCD. They reported a decrease in sperm motility, sperm density, and abnormal morphology in patients with SCD. [12, 47] Osegbe et al. observed no difference in semen volume [33]. Additionally, Friedman et al. reported oligospermia in 3 out of 4 patients with SCD [47].

Similar to Osegbe et al., a recent study also reported a normal volume of ejaculate in 75% of the samples of SCD patients. However, all sperm parameters during HU treatment were affected [47]. There were no incidents of azoospermia in five patients, although a marked decrease in sperm density during the HU treatment compared to before the HU treatment was reported. Interrupting HU treatment did not help recuperate the sperm parameters to initial levels.

However, before HU was established as a standard of care to treat SCD, subfertile range sperm parameters had been reported in patients. More recent studies have reported at least one abnormal sperm parameter in about 90% of patients [47].

HU treatment, even in low doses, exacerbates sperm parameters abnormalities in SCD patients. Therefore, routine seminal fluid parameters assessment is recommended to monitor sperm parameter changes during treatment with HU.

TREATMENTS AVAILABLE

For patients who have abnormal spermatogenesis due to their underlying condition or treatment of the conditions, the option of fertility preservation can be considered. The “optimal” age for fertility preservation is still a discussion. Below are some of the options available [46]-

Erectile dysfunction can be managed with penile implants effectively

Testicular tissue cryopreservation

Gonadal shielding

Sperm cryopreservation

Testicular sperm extraction

Electroejaculation- electrical current to trigger ejaculation.

Symptoms of hypogonadism can be treated with testosterone undecanoate injections12 and clomiphene13

In prepubertal males, patients have very limited experimental options, for example, removal and preservation of part of the testicle [47]. However, there have been no reports of live human births from re-implanted testicular tissue yet.

Counseling about infertility risk associated with the disease and treatments, and options for fertility preservation is important in these situations. Many unresolved ethical dilemmas arise for pediatric patients regarding counseling about fertility issues and preservation. The first dilemma is with whom the responsibility of making the decision should rest. Although some guidelines consider it should be parents, often patients (mostly children in case of SCD) and parents may have different opinions and choices. The American Academy of Pediatrics has published guidelines encouraging healthcare providers to discuss the issues and options with patients and guardians [48].

Since fertility preservation may not be feasible in all cases of SCD, regular monitoring for sperm abnormalities during HU therapy has been suggested.

CONCLUSIONS

HU has significantly improved the treatment outcomes in SCD patients. However, some concerns regarding the cytotoxic effects of HU on spermatogenesis emerge. Extensive research is required to evaluate the before and after treatment sperm parameters and the effects of treatment with HU on spermatogenesis.

Newer medical advances have improved survival rates and reduced disease-related morbidity in SCD patients, bringing reproductive issues to the forefront. Prospective, large population-based studies among patients with SCD are required to determine cellular and functional impairment of fertility and evaluate the impact of HU therapy on the impairment.

The clinical practice and future research should be streamlined to focus on improving the quality of life along with the prognosis of the patients. The patient-centric research will help in better management and treatment of patients with SCD with HU therapy.

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[dabis-azure-songbird]

May I please request headcanons for InuYasha, Sango, and Miroku having a modern-day S/O who suffers from sickle cell disease?

Hello, my darling! This took me a while. I'm so very sorry. So! This was at the tippy top of my list! Of course, you can request this. I tried to research this to the best of my ability, so I hope I did these headcanons justice. I know there are multiple forms, so I'm going to try to write ones that could apply to any of the types. ♥ All my love! XoXo

Pairings: InuYasha x Reader, Sango x Reader, Miroku x Reader who suffers from sickle cell disease

Warnings: None, just some extra love for SCD readers, etc.

Inuyasha

To be honest, I feel he wouldn't understand at all what that means at first.

But he's willing to learn and listen to you. (Still doesn't understand it all...especially doctor jargon)

And you think he isn't listening to you at some point, and then he surprises you by remembering and saying something that you had told him.

His personality is quite brash, so I feel like he's one that seems very strong on the forefront, but secretly studies as much as he can to help you and make you more comfortable.

I definitely think he tries to keep you comfortable. Puts a blanket over you and pats it or rubs your arms and hands if you're cold, or takes it off. Secretly pays very close attention to your cues and body language. Makes sure you have lots of water and adequate rest.

And I feel like he'd go to every appointment with you, arms crossed and face a bit unreadable beneath his baseball cap.

You might catch him crying secretly at night sometimes, but it's only because he loves and cares about you so much, darling. (Bh-huh!? Inuyasha!? Nahhhh >.> You didn't hear that from me!)

And if you need more severe treatments such as blood transfusions, bone marrow, etc, I feel he definitely has them check if he's a match for you first.

He's so loyal. If you're hospitalized or just going to doctors a lot, no matter what it is, he's always by your side.

And be sure to let him know if you're tired or anything! I'm sure he will give you as many piggybacks and let you rest as much as you need while he also keeps careful watch and rests with you.

Overall, he's the best S/O and caretaker he can be to you. I think he might only argue with you if you argued with him over the prices of treatments. Because it's your life and that doesn't matter if you feel better. He'll find a way.

Sango

She's such a sweetie. Even if you identify as a male or whatever you prefer, I feel she always brings you flowers and tries to make you smile in some way.

Works hard to also make sure you are comfortable and your needs are always taken care of.

Research to the end of the world to try to understand you and your condition better.

Like Inuyasha, she is always by your side, especially at appointments and checkups.

If you have to undergo any surgeries or transfusions, she makes sure she's the first person you see besides the doctors.

Is good about reminding you and keeping you on track with your schedule and appointments, medicines, but also dates! Also definitely tries to help you with preventatives to keep you healthy.

I feel her favorite thing is to go out with you to cafes on days you feel well enough to.

Tries to help doctors find you a match for transfusions or marrow if you need it.

She wants to be with you every step of the way. No matter how difficult or easy your path may be.

Sensitive but strong herself, I feel like the two of you can have heart-to-heart talks and rest in each other's arms when it's too stressful. She'll either listen or cry with you.

Just know she's always there and is always fighting beside you.

Miroku

This guy, ahahaha. But no. I feel he adds a bit to your stress since he's a womanizer sometimes...but just know, he's all yours and his heart will always be yours. He looks, but definitely WON'T touch.

I feel he's always trying to make you smile and laugh.

Definitely uses those flirty antics of his to try.

May convince you to have his child...ONLY IF YOU WANT TO.

If this happens, and it possibly causes your pain or anything to be more severe, I really think he feels guilty though.

Definitely seeks care for you and the baby always.

And if you decide not to, that's fine too!

He may seem a bit aloof sometimes, but he really is very serious about you.

I think his aloofness is caused by him being deep in thought about how he can better help and care for you quite honestly. Or if he can try to understand you better.

I feel he's the one to ask the doctors questions and try to help you figure things out better too.

He may miss one or two appointments every now and then, but he'll show up late...with some flowers and maybe your favorite snack in hand or stuffed animal too! (He took too long picking them out honestly.)

His favorite thing would be to cuddle with you at night and hold you. Especially if you're feeling cold or just not all that well.

[metalheadsforblacklivesmatter]

Although both diseases received a similar amount of federal government research funding between 2008 and 2018, the researchers note that SCD is 3 times as prevalent as CF. In addition, the US birth rate of SCD is 1 in 365 black individuals while the US birth rate of CF is 1 in 2500 white individuals.

...

NIH funding per person with CF was greater than that for SCD (mean [SD], $2807 [$175] vs $812 [$147]; P&thinsp;<.001) Philanthropic expenditures were significantly greater per person with CF compared with SCD (mean, $7690 [$3974] vs $102 [$13.7]; P&thinsp;<.001) From 2008 to 2018, annual CF publications remained greater than those of SCD (mean, 1594 [225] vs 926 [157]; P&thinsp;<.001) CF trials were significantly more likely to receive industry funding (mean, 15.6 [5.3] vs 6.8 [1.8]; P&thinsp;=&thinsp;.001) “The funding disparity was markedly increased when factoring in disease-specific private foundation funding,” the researchers said. “The additional research support was associated with greater research productivity and pharmaceutical development for CF compared with SCD.”

Don't get me wrong. I know someone with CF, and recent medical breakthroughs has drastically increased their quality of life. I'm 100% grateful for it.

But it still hurts my heart that Black families whom are more likely to have a family member with sickle cell aren't getting the same treatment.

(Also sickle cell from my understanding is a very painful disease and to think about how black people are often gaslit about their pain.)

-fae

[jcsmicasereports]

Hydroxyurea and Sperm Abnormalities in Patients with Sickle Cell Disease by Dr. Salma M. AlDallal in Journal of Clinical Case Reports Medical Images and Health Sciences 

ABSTRACT

Hydroxyurea is a key treatment option for patients having sickle cell disease. Although the treatment has been effective in improving the survival rate, new concerns over improving quality of life are forthcoming due to spermatogenesis-related toxicities and teratogenic effects. The available evidence shows that hydroxyurea might exacerbate the existing sperm abnormalities. There is a lack of comprehensive, systemic evidence to demonstrate the precise effects and role of hydroxyurea on sperm abnormalities in patients with sickle cell disease. Patients and healthcare providers require accurate and extensive information on sperm-related toxicities to make informed decisions. Here, I discuss the effects of hydroxyurea (HU) on sperm parameters, clinical study evidence, and treatment options available for fertility preservation in these patients.

Keywords: Sickle cell disease, Hydroxyurea, Sperm abnormalities

INTRODUCTION

Sickle cell disease (SCD) is a group of genetic blood disorders that leads to abnormality in hemoglobin. In patients with SCD, newer medical treatments have improved survival rates and quality of life along with a reduced disease-related morbidity. Consequently, the focus of the treatment is diverging to encompass the reproductive issues associated with these treatments. In adolescents and young patients with SCD, sexual maturation is delayed by 1.5-2 years [1, 2], and approximately 24% of SCD patients may have hypogonadism, infertility, erectile dysfunction, and poor libido [3]. The issues related to fertility and reproductive organs in SCD are either related to disease or to the treatments used to treat SCD-related morbidity.

Reduced SCD-related morbidity has been observed with treatments like hydroxyurea (HU) and hematopoietic stem cell transplantation (HSCT). However, adverse effects and toxicities associated with these therapies are a concern. HU use has been associated with sperm abnormalities and teratogenic effects [4, 5]. However, HU affects rapidly dividing cells, raising concerns about related toxicities. Therefore, it is essential to evaluate if there is an exacerbation of fertility problems in men with SCD. This review summarizes the spermatogenic effects of HU in males with SCD.

Fertility issues in males with SCD

Some of the disease-related fertility issues observed in patients with SCD are hypogonadism, sperm abnormalities, erectile dysfunction, delay in sexual maturation, and abnormal hormone (testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH)) levels.

The sperm abnormality rate is as high as 91% in males with SCD [6]. Although some reports attribute sperm abnormalities to delayed puberty in males with SCD [7], some others attribute it to testicular infarction or hypogonadism. It is also worth noting that sperm abnormalities also exist with normal testosterone, FSH, and LH levels [8].

In addition to sperm abnormalities, the incidence of erectile dysfunction in men with SCD is reported to be 21%–35% [9-11]. Also, a decrease in semen is reported in men with SCD [12]. Laboratory findings show low testosterone levels with variable FSH and LH levels. Moreover, abnormalities in accessory organs like seminal vesicles and prostate glands may be present due to recurrent urinary tract infections. These reproductive issues are exacerbated by therapies like HU, which have therapeutic effects through impairing DNA synthesis.

HU in treatment of SCD

HU is approved for the prevention of vaso-occlusive pain in SCD. HU is a ribonucleotide reductase inhibitor that impairs DNA synthesis due to its S-phase-specific cytotoxic action. It is an antimitotic agent that can impair human spermatogenesis. It is a disease-modifying therapy that decreases episodes of acute pain and acute chest syndrome in SCD patients [13]. The HU therapy increases the fetal haemoglobin, which does not sickle under low oxygen tension. Low-dose HU therapy (10 mg/kg/day) has been effective in improving clinical and hematological parameters, reducing painful crises, and reducing blood transfusion requirements in SCD patients. Although HU has improved the quality of life and survival rate, its use is limited by its toxicities, particularly its effect on fertility parameters.

SCD itself manifests in some abnormalities like spermatogenesis, and seminal fluid, which may be exacerbated with cytotoxic HU therapy. HU is associated with abnormal sperm morphology [14] and a decrease in sperm count [14-16] in patients with SCD. At a therapeutic dose, it has short-lived, irregular cytotoxic effects on dividing cells [4]. Since it is an antimetabolite, it is hypothesized to have a risk of affecting sperm development [4]. These effects are often brief and reversible with discontinuation of the drug administration.

Infertility in Men with SCD

Although HU treatment has improved outcomes in patients with SCD, it has been associated with effects on spermatogenesis and teratogenicity, for example, testicular atrophy, hypogonadism, decreased sperm count, abnormal sperm motility, and abnormal sperm morphology.

Hypogonadism

Male hypogonadism is decreased functional activity of the gonads that results in a testosterone deficiency. Testosterone deficiency can cause infertility, muscle wasting, and the absence of secondary sex characteristics. The mechanism for the cause of hypogonadism may be primary gonadal failure [17-19], repeated testicular infarction [20], zinc deficiency [21, 22], and partial hypothalamic hypogonadism [23].

Abnormal spermatogenesis

Impaired spermatogenesis has been reported in male patients with SCD receiving HU therapy, which leads to testicular atrophy, oligozoospermia (low sperm count), abnormal sperm morphology, and azoospermia (decreased sperm motility) [6, 15, 16, 24-31]. It is yet unclear if the abnormalities directly affect HU therapy. However, some researchers believe that the extent of sperm abnormalities might be associated with the length of HU therapy [29, 30]. Since SCD is a genetic condition manifesting at an early age, the duration of HU therapy remains long.

Abnormal Hormone level

A few studies have reported altered levels of testosterone and dihydrotestosterone, FSH, and LH in patients with SCD [12, 32, 33]. The testosterone levels have a direct effect on fertility [6], reduction in semen volume, sperm count, and motility in sickle cell male patients [10].

Priapism

Priapism is defined as a prolonged and lasting continued penile erection unrelated to sexual interest or stimulation [34]. The prevalence of priapism and erectile dysfunction in patients with SCD is 45% and 30%, respectively [35-37].

Penile erection is regulated by the neurotransmitter nitric oxide (NO). In SCD patients, the bioavailability of NO is decreased, disturbing the relaxation of penile smooth muscle [38, 39]. Also, the adenosine regulation pathway might be contributing to the pathophysiology of priapism in SCD patients.

Studies evaluating the effect of HU therapy on spermatogenesis SCD patients

Several studies have reported the role of HU in the exacerbation of various sperm abnormalities in patients with SCD. A non-interventional study (ESCORT-HU-European Sickle Cell Disease Cohort-Hydroxyurea) evaluated safety, morbidity, and mortality in 422 SCD patients of age 15years and older treated with HU [40, 41]. The study reported 67 pre-treatment and 24 during treatment semen analyses. Before treatment with HU, 49% of sperm analyses were normal, and 25% were abnormal (at least 1 abnormality: sperm mobility, sperm count, appearance). The rate of abnormalities during HU treatment increased to 50%. The abnormalities observed were asthenospermia, hypospermia, oligospermia, azoospermia, and atypical forms. These results confirmed that sperm abnormalities are exacerbated after HU treatment.

A prospective, Phase 4 multicentre study called HYDREP (NCT01609192) assessed the effect of HU treatment in patients with SCD [42]. The study reported a significant and rapid decrease in mean total sperm count from 129.8 million at baseline to 24.1 million at month 6. Furthermore, 86% of patients had an abnormal value of total sperm count at month 6 compared to only 40% at baseline. Researchers also found that 6 months of HU treatment did not affect the semen volume. They reported that the treatment of SCD with HU causes significant abnormality in spermatogenesis. After treatment, the number of men with abnormal total sperm count and cryptozoospermia increased to 30 patients and 5 patients, respectively. Additionally, six patients (17%) became azoospermic, and 19 were oligozoospermic.

An unmatched case-control study in Nigeria compared serum testosterone concentration among 47 patients with hemoglobin phenotype SS and 28 volunteers with hemoglobin phenotype AA [43]. The concentrations of serum testosterone in 44 of 47 hemoglobin phenotype SS patients were significantly lower as compared to 7 of 28 volunteers with hemoglobin phenotype AA.

A group of researchers evaluated the effect of long-term HU treatment from childhood to adult age in four patients [44]. These patients were receiving HU treatment for more than 8 years. They observed that two patients experienced severe oligozoospermia and two azoospermia. The treatment exposure in patients experiencing oligozoospermia was shorter (8 and 9 years) compared to patients experiencing azoospermia (12 and 15 years). There was also an increased percentage of abnormal spermatozoa morphology in these patients.

Furthermore, a study assessed spermatogonial quantity in prepubertal patients who received alkylating agents to compare with patients who received non-alkylating agents. They demonstrated that the quantity of spermatogonia per transverse tubular cross-section was significantly low in patients with SCD receiving hydroxyurea (0.3 ± 0.6, n = 6; P = 0.008) [45].Contrarily, a recent study reported no difference in semen volume, sperm concentration, total sperm count, or spermatozoa motility, morphology, and vitality between patients with SCD who received HU before puberty and who did not receive HU during puberty [46].

Semen analysis

A significant reduction in sperm density, ejaculate volume, sperm motility was reported in the SCD patients compared to the control subjects [43]. Likewise, some former studies that performed semen analysis in men with SCA reported a reduction in sperm motility, sperm density, and sperm morphology [44]. Similarly, Osegbe et al. and Agbaraji et al. analyzed sperm density, motility, morphology, and semen volume in patients with SCD. They reported a decrease in sperm motility, sperm density, and abnormal morphology in patients with SCD. [12, 47] Osegbe et al. observed no difference in semen volume [33]. Additionally, Friedman et al. reported oligospermia in 3 out of 4 patients with SCD [47].

Similar to Osegbe et al., a recent study also reported a normal volume of ejaculate in 75% of the samples of SCD patients. However, all sperm parameters during HU treatment were affected [47]. There were no incidents of azoospermia in five patients, although a marked decrease in sperm density during the HU treatment compared to before the HU treatment was reported. Interrupting HU treatment did not help recuperate the sperm parameters to initial levels.

However, before HU was established as a standard of care to treat SCD, subfertile range sperm parameters had been reported in patients. More recent studies have reported at least one abnormal sperm parameter in about 90% of patients [47].

HU treatment, even in low doses, exacerbates sperm parameters abnormalities in SCD patients. Therefore, routine seminal fluid parameters assessment is recommended to monitor sperm parameter changes during treatment with HU.

Treatments Available

For patients who have abnormal spermatogenesis due to their underlying condition or treatment of the conditions, the option of fertility preservation can be considered. The “optimal” age for fertility preservation is still a discussion. Below are some of the options available [46]-

Erectile dysfunction can be managed with penile implants effectively

Testicular tissue cryopreservation

Gonadal shielding

Sperm cryopreservation

Testicular sperm extraction

Electroejaculation- electrical current to trigger ejaculation.

Symptoms of hypogonadism can be treated with testosterone undecanoate injections12 and clomiphene13

In prepubertal males, patients have very limited experimental options, for example, removal and preservation of part of the testicle [47]. However, there have been no reports of live human births from re-implanted testicular tissue yet.

Counseling about infertility risk associated with the disease and treatments, and options for fertility preservation is important in these situations. Many unresolved ethical dilemmas arise for pediatric patients regarding counseling about fertility issues and preservation. The first dilemma is with whom the responsibility of making the decision should rest. Although some guidelines consider it should be parents, often patients (mostly children in case of SCD) and parents may have different opinions and choices. The American Academy of Pediatrics has published guidelines encouraging healthcare providers to discuss the issues and options with patients and guardians [48].

Since fertility preservation may not be feasible in all cases of SCD, regular monitoring for sperm abnormalities during HU therapy has been suggested.

Conclusions

HU has significantly improved the treatment outcomes in SCD patients. However, some concerns regarding the cytotoxic effects of HU on spermatogenesis emerge. Extensive research is required to evaluate the before and after treatment sperm parameters and the effects of treatment with HU on spermatogenesis.

Newer medical advances have improved survival rates and reduced disease-related morbidity in SCD patients, bringing reproductive issues to the forefront. Prospective, large population-based studies among patients with SCD are required to determine cellular and functional impairment of fertility and evaluate the impact of HU therapy on the impairment.

The clinical practice and future research should be streamlined to focus on improving the quality of life along with the prognosis of the patients. The patient-centric research will help in better management and treatment of patients with SCD with HU therapy.

[thebananashapedbloodcell]

Sickle Cell Awareness Month Wrap Up:

Hey everyone! I know we are at the end of September, and I’m hoping you are all well and healthy. Happy Sickle Cell Awareness Month to you all!

September has been a busy month for me personally and I haven’t gotten a chance to sit down and update my blog. Hello to all the new followers and I see so many of you reblogging my posts and I just want to say thank you and I really appreciate it! 🤍🥹

This month, I turned 31 years old and I’m hoping my year to come will be filled with good health, new opportunities and spreading some good energy.

Another big thing I did was a presentation on Sickle Cell Disease! I got the opportunity to speak on my experience with SCD with the help of my social worker and few others! It was all done virtually, so I’ll copy the link down below if you’re interested in getting to know more about me!

Anyways, stay healthy and safe! Thank you again for all the support. It does not go unnoticed 🙏🏾

[georgebuckettwo]

In late 2023, we saw the first-ever approval of CRISPR-based medicine: Casgevy, a cure for sickle cell disease (SCD) and transfusion-dependent beta thalassemia (TDT).

[bitcoinversus]

CRISPR Therapeutics Makes TIME’s Best Inventions of 2024 List

CRISPR Therapeutics has earned a place on TIME‘s “Best Inventions of 2024” list, celebrated for transformative gene-editing therapies that tackle complex genetic disorders. CRISPR’s revolutionary CASGEVY treatment, designed for sickle cell disease (SCD) and transfusion-dependent beta thalassemia (TDT), is the first FDA-approved CRISPR-based…

[farmacuticals]

Expanding Horizons in the Global Sickle Cell Disease Market: Key Trends and Forecasts

Global Sickle Cell Disease (SCD) is a significant hereditary blood disorder that predominantly affects individuals of African, Mediterranean, Middle Eastern, and Indian ancestry. It is caused by a mutation in the hemoglobin gene, leading to abnormally shaped red blood cells. These cells, which take on a rigid, sickle-like form, can block blood flow, leading to episodes of pain, infections, and long-term complications in multiple organs. SCD has severe impacts on quality of life and imposes high healthcare costs on both affected individuals and health systems worldwide. As awareness and diagnostic capabilities grow, the Global Sickle Cell Disease market has seen an increase in focus on research and development, with various pharmaceutical companies investing in innovative therapies.

According to MRFR analysis, the market size for sickle cell disease was projected to reach $3.54 billion (USD billion) in 2022. It is anticipated that the sickle cell disease market would increase from 4.02 billion USD in 2023 to 12.56 billion USD in 2032. The CAGR (growth rate) for the sickle cell disease market is anticipated to be approximately 13.5% from 2024 to 2032.

Global Sickle Cell Disease Size and Share

The Global Sickle Cell Disease market size has expanded considerably in recent years due to rising awareness, advancements in diagnostic tools, and increased government and non-government initiatives. The market is estimated to experience substantial growth, fueled by the rising number of people diagnosed with SCD globally. The largest share of the Global Sickle Cell Disease market is concentrated in regions with high prevalence rates, such as Sub-Saharan Africa and parts of the Middle East, North America, and India. In these regions, the demand for effective treatments and therapies is significant due to the high incidence rates and the lack of widespread access to healthcare solutions in many affected areas. Additionally, collaborations among pharmaceutical companies, research institutions, and health organizations aim to drive the development and accessibility of innovative treatments, leading to a positive impact on the Global Sickle Cell Disease market share.

Global Sickle Cell Disease Analysis

The Global Sickle Cell Disease market analysis underscores several crucial factors that influence growth, including an increasing number of research activities, better diagnostic tools, and advances in gene therapies. Additionally, recent approvals of new medications, such as voxelotor and crizanlizumab, have marked significant progress. Furthermore, the expansion of neonatal screening programs in various countries has enabled early detection, allowing for early intervention and improved patient outcomes. The analysis highlights challenges, such as the high costs associated with treatment, limited access to healthcare facilities in low-resource settings, and social stigmas surrounding genetic conditions in some cultures. Nevertheless, the Global Sickle Cell Disease analysis projects a promising outlook for this market, with emerging therapeutic innovations and increased advocacy for equitable healthcare access in developing regions.

Global Sickle Cell Disease Trends

Key trends driving the Global Sickle Cell Disease market include the development of gene therapies and CRISPR-based treatments. These groundbreaking advancements promise long-term solutions by addressing the root cause of the disease at the genetic level. In addition, there is an increased emphasis on expanding the availability of bone marrow transplants, which can offer a cure for some patients. Digital healthcare solutions, including telemedicine and patient management apps, are also gaining traction to assist in monitoring symptoms and reducing hospital visits. Moreover, collaborations between health organizations and governments to fund research and expand treatment access in affected regions are major trends impacting Global Sickle Cell Disease initiatives worldwide.

Reasons to Buy the Reports

Comprehensive Market Insights: The reports provide detailed analysis on the Global Sickle Cell Disease market, including market size, share, trends, and future growth potential.

Updated Treatment Landscape: Get information on the latest treatment options and their respective regulatory status, helping to understand the competitive landscape.

Regional Market Dynamics: Insight into how the Global Sickle Cell Disease market differs by region, allowing for more effective market entry strategies.

Emerging Trends and Innovations: Stay updated on new research, gene therapies, and advancements in treatment that can revolutionize patient outcomes.

Competitive Intelligence: Assess the key players, partnerships, and recent developments that are shaping the future of the Global Sickle Cell Disease market.

Recent Developments

The recent development of innovative therapies, particularly gene editing solutions such as CRISPR, has fueled optimism within the Global Sickle Cell Disease community. New drugs targeting specific symptoms and complications, such as hydroxyurea alternatives, are in the pipeline. Collaborative research between institutions and biotech companies has increased, with a growing focus on expanding treatments in regions with limited healthcare access. Furthermore, digital healthcare and remote monitoring tools have begun playing a larger role in the management of SCD, allowing patients to track symptoms and receive care virtually.

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[stevenwilliam12]

Epidemiology and Market Forecast for Sickle Cell Disease Up to 2034

Epidemiology of Sickle Cell Disease

Sickle Cell Disease (SCD) is a genetic blood disorder primarily caused by mutations in the HBB gene, leading to the production of abnormal hemoglobin known as hemoglobin S. This condition is characterized by the formation of rigid, sickle-shaped red blood cells, which can cause blockages in small blood vessels, leading to pain, infections, and organ damage.

Globally, approximately 20 million people are living with SCD, with the highest prevalence in regions such as sub-Saharan Africa, India, and the Mediterranean. In the United States alone, around 100,000 individuals are affected, with an estimated 1 in 365 African American births diagnosed with the disease. The prevalence of SCD is particularly concerning in regions with limited healthcare access, where many individuals remain undiagnosed and untreated, leading to higher morbidity and mortality rates.

The World Health Organization (WHO) estimates that SCD contributes to over 200,000 deaths annually, particularly in low-income countries. Increased awareness and improved screening programs are crucial in managing and reducing the disease's burden.

Market Forecast for Sickle Cell Disease

The global market for Sickle Cell Disease is poised for substantial growth in the coming decade. Factors contributing to this expansion include advancements in treatment options, a growing understanding of the disease, and ongoing research into novel therapies.

As of 2023, the SCD treatment market is valued at approximately USD 3 billion and is expected to grow at a compound annual growth rate (CAGR) of around 10% to reach approximately USD 6.5 billion by 2034. This growth is attributed to:

Innovation in Treatment: The approval of new drugs, such as crizanlizumab (Adakveo) and voxelotor (Oxbryta), is diversifying treatment options and improving patient outcomes. Additionally, gene therapies are in clinical trials, promising long-term solutions for SCD.

Increased Awareness and Screening: Enhanced awareness campaigns and newborn screening programs are leading to earlier diagnoses and better management, thereby increasing demand for treatment.

Emerging Markets: Developing regions are witnessing improved healthcare infrastructure, which is critical for diagnosis and treatment. The rise in healthcare investments in these areas will likely lead to increased access to therapies.

Research and Development: Pharmaceutical companies are focusing on research and development to introduce new therapies, which is expected to significantly impact market growth.

In summary, the epidemiology of Sickle Cell Disease underscores a pressing need for improved healthcare interventions, while the market forecast suggests a positive trajectory towards enhanced treatment options and increased market value by 2034. As stakeholders prioritize SCD awareness and treatment, the future holds promise for those affected by this debilitating condition.

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[drgauravkharya]

Dr. Gaurav Kharya: Leading Pediatric Oncologist and Bone Marrow Transplant Specialist in Delhi

Dr. Gaurav Kharya, is an internationally renowned Pediatric Hematologist and Oncologist, known for his expertise in bone marrow transplantation (BMT) and cell and gene therapy. With over 20 years of experience, Dr. Kharya has revolutionized the treatment of pediatric cancer and blood disorders in India, offering hope to patients with complex conditions such as leukemia, sickle cell anemia, thalassemia, and aplastic anemia.

Dr. Gaurav Kharya's Medical Expertise

Dr. Kharya specializes in haploidentical bone marrow transplants,

a procedure used when a 100% HLA match is not available, making it accessible to a wide range of patients. His pioneering work in this area has made him a sought-after expert, particularly for children with blood disorders who lack fully matched donors. He has successfully performed more than 1,000 bone marrow transplants, including over 100 for patients with sickle cell disease (SCD)—the highest by any doctor in India.

Advanced pediatric cancer treatment

As the Clinical Lead at the Center for Bone Marrow Transplant and Cellular Therapy at Apollo Hospitals in New Delhi, Dr. Kharya offers advanced treatment options for pediatric patients. His approach includes cutting-edge therapies like CAR T-cell therapy and gene manipulation, giving children with aggressive cancers and hemoglobinopathies a chance of long-term remission.

Dr. Kharya's international training at prestigious institutions,

including The Great North Children's Hospital in the UK and Imperial College Healthcare NHS Trust in London, has shaped his world-class expertise. He continually brings the latest advancements in pediatric oncology and bone marrow transplantation to his practice in India.

Specialization in Haploidentical Transplants

Dr. Gaurav Kharya is a leading advocate for haploidentical transplants, where the donor is a half-match, usually a family member. Thanks to technological advances, this form of transplant has become increasingly successful, especially for children with diseases like Thalassemia and sickle cell anemia. Dr. Kharya’s work in this field has brought hope to families who previously faced limited treatment options.

Conditions Treated by Dr. Gaurav Kharya

Dr. Kharya treats a wide range of pediatric cancers and hematological conditions, including:

Acute lymphoblastic leukemia (ALL).

Acute Myeloid Leukemia (AML)

Non-Hodgkin's lymphoma

Sickle cell anemia

Thalassemia

Aplastic anemia

Primary Immunodeficiency Disorders

His holistic approach ensures that each child receives personalized care, from diagnosis to treatment and post-transplant recovery.

Achievements and contributions to medical research

Dr. Kharya is not only a skilled clinician but also an active contributor to medical research. He has published extensively on bone marrow transplantation and cell therapy, particularly in the development of new treatment protocols for pediatric cancer and blood disorders. His work in gene therapy and immunotherapy is paving the way for groundbreaking treatments that are set to transform the future of cancer care in India.

Personalized care and patient support

Dr. Kharya emphasizes compassionate care, guiding families through the often-complex process of bone marrow transplantation. He works closely with his team of specialists to ensure that every patient receives the highest level of care, from pre-transplant conditioning to post-transplant recovery.

Families under his care benefit from his dedication to patient education and support. Dr. Kharya ensures that parents understand the intricacies of their child’s treatment plan, including the risks, benefits, and necessary precautions post-transplant.

A Visionary Leader in Pediatric Oncology

Dr. Gaurav Kharya’s vision is to make advanced treatment options like bone marrow transplantation and CAR T-cell therapy accessible to all children in need. Through his work at Apollo Hospitals and Cellogen Therapeutics, he continues to push the boundaries of pediatric cancer care, giving hope to countless families.

[drcare4u]

The fight against sickle cell disease: how one hospital in rural Maharashtra is making a difference

I know sickle cell disease (SCD) less from medical textbooks and more from the suffering of patients I’ve treated. Over time, this disease has ceased to be just a diagnosis on a chart. It has become something I deeply despise from the core of my being. It has drawn many of my young, tender-looking patients into painful crises, causing me to cry out in desperation, hoping to see it eradicated —…

[regenhealthsolutions]

Pfizer Voluntarily Withdraws All Lots of Sickle Cell Disease Treatment OXBRYTA® (voxelotor) From Worldwide Markets

 Pfizer Inc. (NYSE: PFE) announced today that it is voluntarily withdrawing all lots of OXBRYTA ® (voxelotor) for the treatment of sickle cell disease (SCD) at this time, in all markets where it is approved. Pfizer is also discontinuing all active voxelotor clinical trials and expanded access programs worldwide. Pfizer’s decision is based on the totality of clinical data that now indicates the…

[blessihomehllc]

Sickle cell disease (SCD) is a genetic blood disorder affecting millions worldwide. It is characterized by the production of abnormal hemoglobin, which causes red blood cells to assume a sickle shape, leading to severe health complications. Understanding SCD is crucial for caregivers who are pivotal in managing the condition. This guide provides essential information to help caregivers support individuals with SCD effectively. Proper caregiver training is essential to ensure caregivers have the knowledge and skills to provide optimal care.

[thebananashapedbloodcell]

You already know what day it is!!

Happy World Sickle Cell Day! This is truly one of my favourite days of the year as we get to celebrate, educate and support each other as we deal with this disease. Whether you are a person with the disease personally, a health care provider of those with SC or a family/friend supporting a loved one, just know your efforts do not go unnoticed.

One new piece of information that I learned about when it comes to SCD is that pain from a Sickle Cell crisis can be connected to terminal cancer. (Check out the SCAGO website for more information on SCD)

Anyways, I hope you all learned something new today or shared information on this disease with family/friends.

Take care and stay healthy

Photo credits: @sicklecell101

[datawater]

SCD