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Background: Sickle cell anaemia (SCA) is an inherited hemoglobinopathy resulting in sickling of erythrocytes that cause micro-vascular obstruction leading to acute complications and chronic organ damage. Adults with SCA have endocrine complications and metabolic alterations. The aim of this study was to assess the association between gonadal and thyroid hormones with iron indices and to explore the potential association between serum ferritin levels and sex hormones in adult males with sickle cell disease in New Prince Saud Bin Jalawy Hospital (NPSBJH) in Hofuf city (Eastern region of Saudi Arabia) where there are many patients with SCA. Methods: A cross-sectional analytical study was carried out in the Haematology Clinic at NPSBJH in 2018. A total of eighty (80) male patients with sickle cell anaemia were included in this study and were divided into two groups according to serum ferritin level. Group I (G-I): Included 40 male patients with high serum ferritin level and group II (G-II): included 40 male patients with normal serum ferritin level. Results: There was a significant difference in height/cm between GI and Gil, P value= 0.006. Serum ferritin was significantly higher in GI (P value= 0.000), and serum TIBC was significantly higher in G-II. (P value= 0.022). Testosterone level was significantly higher in G-II (P value= 0.018). Luteinizing hormone (LH) was significantly higher in group I (P-value 0.019). There was a significant relation between serum ferritin level in G-I and the following: serum iron, TIBC, serum testosterone, LH, prolactin, free T3 and free T4. Conclusion: Adult males with SCD with high serum ferritin level were shorter than adult males with SCD who had normal serum ferritin level and had a significant lower level of serum testosterone and significant high level of LH and this was most likely due to endocrine dysfunction secondary to high ferritin level and iron overload.

Background: Blood transfusion is a key treatment of sickle cell disease (SCD) complications. Delayed hemolytic transfusion reaction (DHTR) is a delayed reaction, that occurs days to weeks following a transfusion, characterized by mild anemia and/or hyperbilirubinemia and is one of the serious complications of blood transfusion. The symptoms of DHTR resemble those of vaso-occlusive crisis secondary to SCD leading to difficulty or delaying in diagnosis of DHTR. DHTR may lead to multiple organ failure and death. Case Report: A 31-year-old female patient with a known case of SCD presented to our ER in King Fahad hospital Hofuf in the Kingdom of Saudi Arabia, with a history of generalized body ache, exertional dyspnoea, headache and easy fatigability for a few days on a background history of episodic hospital admissions for SCD, but she was admitted 3 times over the previous 6 months and received 6 units of packed red blood cells (PRBCs). The last blood transfusion was 18 days earlier. She was sick and her Hb level was 4.5 g/dL with positive Coombs test and positive alloantibodies, diagnosed as DHTR. We treated her with prednisolone tablets 1 mg/kg daily, intravenous immunoglobulins, 0.4 gm/kg daily for 5 days, and rituximab 500 mg IV every week for 4 weeks. Her Hb level raised up to 8.2 g/dL and she was discharged in good condition. Conclusion: Identifying risk factors for DHTR by history and presentation is urgently needed in order to risk stratify the transfusion regimen. It is important to avoid additional transfusions in these patients if possible because these may exacerbate the hemolysis and worsen the degree of anemia.

Background: Antibiotics are one of the commonly prescribed drugs over the world. Overprescribing of antibiotics may result in serious bacterial resistance. The main cause of inappropriate prescription of antibiotics is the absence of guidelines and protocols for its use. The aim of this study was to evaluate the appropriate use of ceftriaxone (broad-spectrum third generation cephalosporin antibiotic) in internal medicine wards of Wad Medani teaching hospital in Sudan, as well as comparing its use with reference to the standard of Sudan treatment guidelines and reliable references like British National Formula (BNF) and Sanford guide. Methods: Prospective cross –sectional study conducted in the internal medicine department at Wad Medani Teaching hospital by reviewing the files of all in-patients admitted to medical wards, who received ceftriaxone between November and December, 2018 and the appropriateness use of ceftriaxone was evaluated depending on six criteria: indication, dose, frequency, duration of treatment, culture and sensitivity test and drug –drug interaction Results: A total of 280 admitted patient’s treatment chart containing ceftriaxone injection were analyzed. Ceftriaxone was indicated empirically in 91.1% mostly for respiratory tract infection (35%). Ceftriaxone appropriate dose was given in 59% of patients, inappropriate frequency in 68.9% and incorrect duration in 51.1%. Co-administered drugs with major interaction in 3.6% of patients. Conclusions: This study revealed high inappropriate use of ceftriaxone where it was given without implementing culture and sensitivity test in the majority of patients. This may result in treatment failure so educational programs is recommended to address the irrational use of antibiotic.

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