Eissa, AA; (2014) The clinical and haematological effects of hormonal contraception on women with sickle cell disease. Doctoral thesis , UCL (University College London).

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Abstract

Sickle cell disease (SCD) is known to be a prothrombotic condition; this is also true for combined hormonal contraceptives (HC), which increases the thrombotic risks in their users. Recently, Sickle Cell Trait (SCT) has been reported to carry increased risks of thrombosis Nonetheless, HC methods are efficacious and widely used while, pregnancy carries major risks for SCD women. Hence, there is a need for robust evidence about the safety or risks of HC in SCD and SCT to aid in the choice of contraceptive methods for these women. This study aimed to test the hypothesis that there are no additional clinical or haematological risks to SCD patients and women with SCT using hormonal contraceptive methods that is over and above those inherent in their SCD and SCT status. This is a multi-­‐centre, prospective cohort study, which looked at and compared clinical complications, haemostatic and haematological markers in 68 women with SCD, 22 women with SCT and 27 similar women with normal haemoglobin. In conclusion a two year follow-­‐up of women with SCD using Combined Oral Contraception (COC) found no incidence of Venous Thrombo Embolism (VTE) in these women and the occurrence of other clinical complications, such as sickle-­‐cell crises, the need for blood transfusion and hospital admissions were minimal. It also demonstrated that these complications are comparable to women with normal haemoglobin using COC. Also the use of COC in women with SCD did not significantly alter the haemostatic markers studied, nor did it adversely affect their liver function or exacerbate any inflammatory changes. Progestogen only contraception (POC) use is associated with an increased incidence of menstrual irregularities which are not significantly different from those noted in women with normal haemoglobin taking POC. SCT women manifested increased prothrombotic tendencies, which are more marked in women using COC, while women with 4 normal haemoglobin showed increased inflammatory and endothelial activation markers regardless of the type of contraception used.

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