**Question:** All are used for contraception in sickle cell anaemia except

A. Oral contraceptives
B. Progesterone-only pills
C. Lactational amenorrhea method (LAM)
D. Surgical sterilization

**Correct Answer:** .

**Core Concept:**
Sickle cell anaemia is an inherited blood disorder characterized by the production of abnormal hemoglobin (HbS) in red blood cells, leading to their crippling and reduced life span. This causes chronic anemia, pain crises, and potential organ damage due to reduced circulation. Contraception plays a crucial role in preventing unintended pregnancies in this population.

**Why the Correct Answer is Right:**
The correct answer refers to hormonal contraceptives, specifically Oral contraceptives (OCs) and progesterone-only pills. These options are contraindicated in patients with sickle cell anaemia due to the increased risk of severe complications.

**Why Each Wrong Option is Incorrect:**

A. Oral contraceptives (OCs) are a combination of estrogen and progesterone hormones. In sickle cell anaemia patients, OCs can exacerbate the disease by causing vaso-occlusive crises, acute chest syndrome, and stroke. These complications are due to the hormonal imbalance and increased vasoconstriction caused by OCs.

B. Progesterone-only pills (POPs) are also contraindicated in sickle cell anaemia patients for similar reasons as OCs. Progesterone can cause vaso-occlusive crises and acute chest syndrome due to increased vasoconstriction and altered haemoglobin levels.

C. Lactational amenorrhea method (LAM) is a method of contraception that relies on breastfeeding to suppress ovulation and menstruation, thereby preventing pregnancy. However, in sickle cell anaemia, LAM is not recommended as it could lead to increased risk of vaso-occlusive crises and acute chest syndrome due to the hormonal imbalance and altered haemoglobin levels.

D. Surgical sterilization, including vasectomy in men and hysterectomy in women, is a permanent method of contraception that does not pose a risk in sickle cell anaemia patients. Therefore, this method of contraception is safe and recommended for these patients.

**Clinical Pearls:**

1. Despite the potential risks associated with hormonal contraceptives in sickle cell anaemia patients, other non-hormonal methods like LAM, condom use, and surgical sterilization are safe and recommended options.
2. In sickle cell anaemia, the use of hormonal contraceptives (OCs and POPs) is contraindicated due to the increased risk of vaso-occlusive crises, acute chest syndrome, and stroke.
3. Haemoglobinopathies like sickle cell anaemia can cause a state of hormonal imbalance, leading to altered haemoglobin levels and increased risk of vaso-occlusive crises, acute chest syndrome, and stroke when hormonal contraceptives like