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Problems and challenges in assessing fertility and pregnancy in patients with thalassemia major - some key points from transfusion-dependent thalassemia guidelines

Elena Marinova

Abstract

Over the last decades, the medical care of patients with thalassemia major has improved significantly, with life expectancy being close to that of the rest of the population. At the same time, the quality of life of patients has also improved significantly, and they are able to have families of their own. For medical specialists, this issue raises the question about ensuring normal sexual development, puberty, fertility and pregnancy. Some of the patients suffer hypogonadotrophic hypogonadism and they need assisted reproductive techniques. Fertility and induction of spermatogenesis in male patients with thalassemia is less successful. The suitability to carry to term includes evaluation of cardiovascular system, liver function, dysfunction in other endocrine organs and concomitant viral infections. The article presents the specific characteristics in the planning of spontaneous and assisted pregnancy, the risks associated with that, the drugs that can be applied and the way of delivery.

Keywords

thalassemia major, fertility, pregnancy

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References

Skordis N, Christou S, Koliou M, et al. Fertility in female patients with thalassemia. J Pediatr Endocrinol Metab 1998;11 (Suppl 3):935-43.

Chatterjee R, Katz M. Reversible hypogonadotrophic hypogonadism in sexually infantile male thalassaemic patients with transfusional iron overload. Clin Endocrinol (Oxf) 2000; 53:33-42.

Калева В,Петрова К, Димова М, Трансфузионно независима таласемия, сп. Педиатрия, 2017, стр. 21-26

Nassar AH, Usta IM, Rechdan JB, et al. Pregnancy in patients with beta-thalassemia intermedia: outcome of mothers and newborns. Am J Hematol 2006;81:499-502.

De Sanctis V, Vullo C, Katz M, et al. Gonadal function in patients with beta thalassaemia major. J Clin Pathol 1988a;41:133-7.

De Sanctis V, Vullo C, Katz M, et al. Induction of spermatogenesis in thalassaemia. Fertil Steril 1988b;50:969-75.

Aessopos A, Karabatsos F, Farmakis D, et al. Pregnancy in patients with well-treated betathalassemia: outcome for mothers and newborn infants. Am J Obstet Gynecol 1999;180:360-5.

Skordis N, Petrikkos L, Toumba M, et al. Update on fertility in thalassaemia major. Pediatr Endocrinol Rev 2004;Suppl 2:296-302.

Deech R. Legal and ethical responsibilities of gamete banks. Hum Reprod 1998;13:S80-3.

De Sanctis V, Soliman A, Yassin M. An overview of male reproduction in thalassaemia. Rivista Italiana di Medicina dell’Adolescenza 2012;10:2.

De Sanctis V, Perera D, Katz M, et al. Spermatozoal DNA damage in patients with B thalassaemia syndromes. Pediatr Endocrinol Rev 2008;6:S185-189.

Perera D, Pizzey A, Campbell A, et al. Sperm DNA damage in potentially fertile homozygous betathalassaemia patients with iron overload. Hum Reprod 2002; 17:1820-5.

Димова М., Каназирев Б., Златева В., Калева В., Герчева Св., Петрова Кр., Епидемиология и патофизиология на сърдечно-съдовото засягане при пациенти с бета-таласемия майор, Наука Кардиология, брой 2, 2017

Димова М., Каназирев Б., Златева В., Калева В., Герчева Св., Петрова Кр. Бета-Таласемия и маркери за ранно сърдечно-съдово засягане, Наука Кардиология , брой 3, 2017

Hui PW, Lam YH, Chen M et al. Attitude of at-risk subjects towards preimplantation genetic diagnosis of alpha- and beta-thalassaemias in Hong Kong. Prenat Diagn 2002;22:508-11.

Anderson LJ, Holden S, Davis B, et al. Cardiovascular T2-star (T2*) magnetic resonance for the early diagnosis of myocardial iron overload. Eur Heart J 2001;22:2171-9.

Galanello R, Origa R. Beta-thalassemia. Orphanet J Rare Dis 2010;5:11

Singer ST, Vichinsky EP. Deferoxamine treatment during pregnancy: is it harmful? Am J Hematol 1999;60:24-6.

Tuck SM. Fertility and pregnancy in thalassemia major. Ann N Y Acad Sci 2005;1054:300-7.

Ansari S, Azarkeivan A, Tabaroki A. Pregnancy in patients treated for beta thalassemia major in two centers (Ali Asghar Children's Hospital and Thalassemia Clinic): outcome for mothers and newborn infants. Pediatr Hematol Oncol 2006;23:33-7.

Daskalakis GJ, Papageorgiou IS, Antsaklis AJ, et al. Pregnancy and homozygous beta thalassaemia major. Br J Obstet Gynaecol 1998;105:1028-32.

Butwick A, Findley I, Wonke B. Management of pregnancy in a patient with beta thalassaemia major. Int J Obstet Anesth 2005;14:351-4.

Димова М, Калева В, Кашлов Я, Лечение на сърдечната недостатъчност при пациенти с бета-таласемия, сп. „Сърце-Бял дроб“ 2017, 18-30

Kypris L, Simamonian K, Efstathiou E et al. Cardiac monitoring during pregnancy in women with Thalassemia Major [abstract]. 12th International Conference on Thalassaemia and The Haemoglobinapathies, 2011.

Eldor A, Rachmilewitz EA. The hypercoagulable state in thalassemia. Blood 2002;99:36-43.

Tuck SM, Jensen CE, Wonke B, et al. Pregnancy management and outcomes in women with thalassaemia major. J Pediatr Endocrinol Metab 1998;11:S923-8.

Leung TY, Lao TT. Thalassaemia in pregnancy. Best Pract Res Clin Obstet Gynaecol 2012;26:37-51.

Perniola R, Magliari F, Rosatelli MC, et al. High-risk pregnancy in ß-thalassemia major women. Report of three cases. Gynecol Obstet Invest 2000;49:137-139.

Tsironi M, Karagiorga M, Aessopos A. Iron overload, cardiac and other factors affecting pregnancy in thalassemia major. Hemoglobin 2010;34:240-50.

Bajoria, R., Chatterjee, R. Current perspectives of fertility and pregnancy in thalassemia. Hemoglobin 2009;33:S131-5.

Tsironi M, Ladis V, Margellis Z, et al. Impairment of cardiac function in a successful full-term pregnancy in a homozygous ß-thalassemia major: does chelation have a positive role? Eur J Obstet Gynecol Reprod Biol 2005;120:117-118.

Borgna-Pignatti C. Thalassemia. A few new tiles in a large mosaic. Haematologica 2006a;91:1159-61.

Borgna-Pignatti C, Cappellini MD, De Stefano P, et al. Cardiac morbidity and mortality in deferoxamine- or deferiprone-treated patients with thalassemia major. Blood 2006b;107:3733-7.

Howard J, Tuck S, Eissa A, et al. Hemoglonpathies in Pregnancy. In: Cohen H, O’Brien P (ed) Disorders of Thrombosis and Hemostasis in Pregnancy. Springer - Verlag: London, 2012

Singer ST, Vichinsky EP, Gildengorin G, et al. Reproductive capacity in iron overloaded women with thalassemia major. Blood 2011;118:2878-81.


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