The Role of Wheat Grass Juice in Blood Transfusion Requirement of Intermediate Thalassemia

ARNAB BHATTACHARJEE BARRACKPORE RASTRAGURU SURENDRANATH COLLEGE M.Sc Vth year Roll Number: 06G4MMS016
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Definition:
 Thalassemia is inherited disorders

characterized by reduced or absent amounts of hemoglobin, the oxygencarrying protein inside the red blood cells

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Structure of Haemoglobin

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Three Basic Groups of Thalassemia Disorder
 Alpha Thalassemia  Beta Thalassemia •

HbE Thalassemia

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Beta Thalassemia
 It is caused by a change in the gene for

the beta -globin component of hemoglobin.  It can cause variable anemia that can range from moderate to severe.

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There are 3 types of Beta Thalassemia

Thalassemia Minor

Thalassemia Intermediate. Thalassemia Major or Cooley's Anemia

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GENETICS OF THALLASSEMIA
α chains Chromosome 16 ß chains chromosome 11

Translation Rate

α α α

α

ß

ß α

α

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Demographics: Thalassemia

Beta Thalassemia trait is seen most commonly in people with the following ancestry: Mediterranean (including North African, and particularly Italian and Greek), Middle Eastern, Indian, African, Chinese, and Southeast Asian (including Vietnamese, Laotian, Thai, Singaporean, Filipino, Cambodian, Malaysian, Burmese, and Indonesian

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PREVALENCE

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OUR GLOBAL POSITION

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Symptoms of Beta Thalassemia
 It is characterized by severe anemia that

can begin months after birth.  Paleness  Delays in growth and development  Bone marrow expansion.  Untreated Beta Thalassemia major can lead to child death due to heart failure.
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Treatment of Beta Thalassemia
 Regular blood transfusion helps prevent

severe anemia and allows for more normal growth and development.  There are various medications that target the production of red blood cells (i.e. erythropoeitin)

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Body iron Distribution and Storage

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Why we need Iron…..
 Enzymes  Oxygen Transport

- Haemoglobin (Red Blood cells) - Myoglobin (Muscle cells) About 70% of body’s Iron is in these proteins.

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We cope well with Iron shortage……
 Iron deficiency is the most common

deficiency state in the world - Blood Loss - Diet  About 1000 mg of Iron in the body is stored as ferritin  Intestinal Iron deficiency Increases iron absorption.
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…..but poorly with iron excess.
 Iron is excreted by shredding of Intestinal

cells  There is no physiologic mechanism to excrete excess iron.

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Blood transfusions overwhelms the Iron balance
Normal daily iron flux:
Each unit of PRBC:

1-2 mg

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WHY TOO MUCH IRON IS A BAD THING?

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HOW DO WE KNOW IF THERE IS TOO MUCH IRON?
 Serum Ferittin concentration  Liver Biopsy

 Magnetic Resonance Imaging (MRI)

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LESSONS FROM THALLASSEMIA

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SUMMARY
TOO MUCH IRON IS BAD

WHAT CAN WE DO ABOUT IT?
IRON CHELATION
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WHAT IS CHELATION THERAPY?

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HOW TO CHELATE?
 CURRENTLY

LICENCED --- Deferoxamine ( Desferal ) ---- Deferasirox (ICL 670,Exjade )

 ALTERNATIVE

-----Deferiprone

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SIDE EFFECTS
 Local reactions  Opthalmologic  Hearing loss  Zinc deficiency  Reports of Kidney Failure, worsening Blood

counts

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New Lease of life

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EVEN OUR ANCESTORS KNEW ABOUT IT……
Wheatgrass and other cereal grasses have been thoroughly researched and reported as a therapeutically effective substance since the 1930’s. Traditionally, chlorophyll, or its synthetic derivative, chlorophyllin, has been implicated as the biologically active substance responsible for reported healing effects
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The Pilot study

Dr. R. K.Marwaha et al at the Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Entitled “Wheat grass juice reduces transfusion requirement in patients with thalassemia major: a pilot study.”, the study was performed between February 2000 and May 2003. Sixteen out of 38 (42%) blood transfusion dependent thalassemics fulfilled the trial criteria for final analysis. To summarise the findings during period of wheatgrass juice ingestion: • all participants experienced lower blood transfusion requirements • 50% had at least 25% reduction in transfusion requirements • the mean interval between transfusions increased 29.5% • overall, Hemoglobin levels were not compromised by reduced transfusion volumes

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The Inferences drawn….
 Chlorophyll is enhancing the Hemoglobin

function.
 Induction of fetal Hemoglobin (Hb F)

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So what the experts say…
 No

role of chlorophyll.  There is no measurable amount of HbF formed  It is basically a food supplement that contains Oxalic and Malic acids that trap iron in RBCs and slow down their decay  The extract was also found to reduce absorption of iron in the intestine.  Anti-oxidizing properties of the juice
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The 7 Day wonder …..
th

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Added Benefits??
It doesn’t contains appreciable amount of Iron.  It contains; vitamins A, C, E, K, B1, B2, B6, B12; Niacin, Pantothenic acid, Biotin, Folic acid; Chlorophyll, Superoxide dismutase; Calcium, Phosphorus, Potassium, Magnesium,iron, Selenium, Zinc, Iodine, Copper, Cobalt, Sulphur, and other trace minerals; and twenty amino acids.

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How can I help the cause of Thalassemia?
 Get yourself tested for Thalassemia Minor  For care of Thalassaemia Major children :  Donate blood regularly.  Provide financial support for Thalassemia

patients.

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References:
     

1. Kirkman, N.F. 1939. The effect of low-porphyrin diet on erythropoiesis and hemoglobin regeneration. J Physiol 95:508-515 2. Kelentei, B., Fekete, I., Kun, F. 1958. Influence of copper chlorophyllin on experimental anemia. Acta Pharm Hung28:176-180 3. Borisenko, A.N., Sofonova, A.D. 1965. Hemopoietic effect of Na chlorophyllin. Vrach Delo 9:44-46 4. Gruskin, B. Chlorophyll – its therapeutic place in acute and suppurative disease. 1940. American Journal of Surgery. 5. Collings, G. 1945. Chlorophyll and adrenal cortical extract in the local treatment of burns. American Journal of Surgery70:58- 63. 6. Egner, P.A., Munoz, A., Kensler, T.W. 2003. Chemoprevention with chlorophyllin in individuals exposed to dietaryaflatoxin. Mutat Res. 2003 Feb-Mar;523-524:209-16. 7. Ben-Ayre, E., Goldin, E., Wengrower, D., Stamper, A., Kohn, R., Berry , E. 2002. Wheat grass juice in the treatment of active distal ulcerative colitis: a randomized double-blind placebo-controlled trial. Scand J Gastroenterol 2002;37:444-449

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