Details

Autor(en) / Beteiligte

• Krishnan, Ananya
• Balasubramanian, Ramya
• Brown, G. Thomas
• Arlova, Alena
• Lou, Hong
• Maher, Jacqueline
• Gomez-Lobo, Veronica

Titel

48. Follicular Density and Ovarian Histology in Individuals with Sickle Cell Disease and Beta Thalassemia

Ist Teil von

• Journal of pediatric & adolescent gynecology, 2023-04, Vol.36 (2), p.193-193

Ort / Verlag

Elsevier Inc

Erscheinungsjahr

2023

Link zum Volltext

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Treatment for sickle cell disease (SCD) and beta thalassemia (BT) can include repeated blood transfusions or bone marrow transplantation (BMT) which can negatively impact ovarian reserve, an indicator of fertility. Disease pathophysiology, prior treatment like hydroxyurea, or iron deposition from recurrent blood transfusions may all impact ovarian reserve, but recent research suggests that SCD patients may have decreased ovarian reserve even prior to transplant status. Patients may choose to undergo ovarian tissue cryopreservation (OTC) prior to BMT to preserve fertility, and tissue collected from OTC provides an opportunity to study follicular density and iron deposition. Following OTC, ovarian tissue H&E stained slides for 21 patients were obtained from the Oncofertility Consortium and an academic center. The slides were examined by an AI developed by the National Cancer Institute to identify follicles. Follicle count and presence of ovarian cortex was confirmed via human observation. In samples with cortex detected, mean follicular density (MFD) was calculated within an area 1 mm from the edge of the cortex. Select slides were also available to stain with Prussian Blue to detect the presence of iron and were compared to controls who had undergone OTC prior to receiving chemotherapy. Scheuer's iron scoring system was used to grade levels of iron deposition. Histological findings were compared with available clinical indicators of ovarian reserve such as AMH and FSH. AMH < 1.1 ng/mL was used as a cut-off for diminished ovarian reserve (DOR). Younger SCD patients generally had a higher MFD. The patient with the highest MFD prior to BMT had the lowest AMH (0.91) in DOR range. Of the patients with clinical data, 2/9 of the patients had AMH levels indicative of DOR prior to BMT, and 4/8 patients had elevated FSH and very low/undetectable AMH levels 1-2 years post BMT suggesting acute POI. Iron was detected in all SCD and BT patients with Prussian-blue stained slides other than the youngest patient, while the 7 control patients did not show any iron deposition. In both SCD and BT patients, follicles were observed beyond the cortex and deeper into the medulla. This is the first study to observe presence of iron deposition in the ovary in SCD and BT patients and absence in controls. The data shows that patients can experience DOR prior to transplant and that older patients may have reduced MFD compared to MFD values from existing literature. This reduced MFD may be due to age, disease pathophysiology, chronic transfusions or hydroxyurea treatment, emphasizing the need for OTC. In young patients, more thorough tissue processing may be necessary to prevent follicle loss from discarded medulla. Supporting Figures or Tables https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1378941-1-ANY(4).docx https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1378941-2-ANY(3).docx