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

ARNAB BHATTACHARJEEARNAB BHATTACHARJEE

BARRACKPORE RASTRAGURU BARRACKPORE RASTRAGURU SURENDRANATH COLLEGESURENDRANATH COLLEGE

M.Sc Vth yearM.Sc Vth year

Roll Number: 06G4MMS016Roll Number: 06G4MMS016

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Definition:Definition:

Thalassemia is inherited disorders Thalassemia is inherited disorders characterized by reduced or absent characterized by reduced or absent amounts of hemoglobin, the oxygen-amounts of hemoglobin, the oxygen-carrying protein inside the red blood cellscarrying protein inside the red blood cells

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Structure of HaemoglobinStructure of Haemoglobin

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Three Basic Groups of Three Basic Groups of Thalassemia DisorderThalassemia Disorder

Alpha ThalassemiaAlpha Thalassemia

Beta ThalassemiaBeta Thalassemia

HbE ThalassemiaHbE Thalassemia

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Beta ThalassemiaBeta Thalassemia

It is caused by a change in the gene for It is caused by a change in the gene for the the betabeta -globin component of -globin component of hemoglobin.hemoglobin.

It can cause variable anemia that can It can cause variable anemia that can range from moderate to severe.range from moderate to severe.

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There are 3 types of Beta There are 3 types of Beta ThalassemiaThalassemia

Thalassemia MinorThalassemia Minor

Thalassemia IntermediateThalassemia Intermediate. .

Thalassemia MajorThalassemia Major or or Cooley's AnemiaCooley's Anemia

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Chromosome 16 chromosome 11

α chains ß chains

Translation Rate

α

α

αß

ßαα

α

GENETICS OF THALLASSEMIAGENETICS OF THALLASSEMIA

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Demographics: ThalassemiaDemographics: Thalassemia• Beta Thalassemia trait is seen Beta Thalassemia trait is seen

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

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PREVALENCEPREVALENCE

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OUR GLOBAL POSITIONOUR GLOBAL POSITION

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Symptoms of Beta ThalassemiaSymptoms of Beta Thalassemia

It is characterized by severe anemia that It is characterized by severe anemia that can begin months after birth.can begin months after birth.

PalenessPaleness Delays in growth and developmentDelays in growth and development Bone marrow expansion.Bone marrow expansion. Untreated Beta Thalassemia major can Untreated Beta Thalassemia major can

lead to child death due to heart failurelead to child death due to heart failure..

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Treatment of Beta ThalassemiaTreatment of Beta Thalassemia

Regular blood transfusionRegular blood transfusion helps prevent helps prevent severe anemia and allows for more normal severe anemia and allows for more normal growth and development.growth and development.

There are various medications that target There are various medications that target the production of red blood cells (i.e. the production of red blood cells (i.e. erythropoeitin)erythropoeitin)

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Body iron Distribution and Body iron Distribution and StorageStorage

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Why we need Iron…..Why we need Iron….. EnzymesEnzymes Oxygen TransportOxygen Transport

- Haemoglobin (Red Blood cells)- Haemoglobin (Red Blood cells)

- Myoglobin (Muscle cells)- Myoglobin (Muscle cells)

About 70% of body’s Iron is in these About 70% of body’s Iron is in these proteins.proteins.

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We cope well with Iron We cope well with Iron shortage……shortage……

Iron deficiencyIron deficiency is the most common is the most common deficiency state in the worlddeficiency state in the world

- Blood Loss- Blood Loss

- Diet- Diet About 1000 mg of Iron in the body is About 1000 mg of Iron in the body is

stored as stored as ferritinferritin Intestinal Iron deficiency Increases iron Intestinal Iron deficiency Increases iron

absorption.absorption.

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……..but poorly with iron excess...but poorly with iron excess.

Iron is excreted by shredding of Intestinal Iron is excreted by shredding of Intestinal cellscells

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

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Blood transfusions overwhelms the Blood transfusions overwhelms the Iron balanceIron balance

Normal daily iron Normal daily iron flux:flux:

1-2 mg1-2 mg

Each unit of PRBC:

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WHY TOO MUCH IRON IS A BAD WHY TOO MUCH IRON IS A BAD THING?THING?

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HOW DO WE KNOW IF THERE IS HOW DO WE KNOW IF THERE IS TOO MUCH IRON?TOO MUCH IRON?

Serum Ferittin concentrationSerum Ferittin concentration

Liver BiopsyLiver Biopsy

Magnetic Resonance Imaging (MRI)Magnetic Resonance Imaging (MRI)

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LESSONS FROM THALLASSEMIALESSONS FROM THALLASSEMIA

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SUMMARYSUMMARY

TOO MUCH IRON IS BADTOO MUCH IRON IS BAD

WHAT CAN WE DO ABOUT IT?

IRON CHELATIONIRON CHELATION

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WHAT IS CHELATION WHAT IS CHELATION THERAPY?THERAPY?

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HOW TO CHELATE?HOW TO CHELATE?

CURRENTLY LICENCEDCURRENTLY LICENCED

--- Deferoxamine ( Desferal )--- Deferoxamine ( Desferal )

---- Deferasirox (ICL 670,Exjade )---- Deferasirox (ICL 670,Exjade )

ALTERNATIVEALTERNATIVE

-----Deferiprone-----Deferiprone

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SIDE EFFECTSSIDE EFFECTS Local reactionsLocal reactions

OpthalmologicOpthalmologic

Hearing lossHearing loss

Zinc deficiencyZinc deficiency

Reports of Kidney Failure, worsening Blood Reports of Kidney Failure, worsening Blood countscounts

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New Lease of lifeNew Lease of life

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EVEN OUR ANCESTORS KNEW EVEN OUR ANCESTORS KNEW ABOUT IT……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 studyThe 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….The Inferences drawn….

Chlorophyll is enhancing the Hemoglobin Chlorophyll is enhancing the Hemoglobin function.function.

Induction of fetal Hemoglobin (Hb F)Induction of fetal Hemoglobin (Hb F)

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So what the experts say…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 7The 7thth Day wonder ….. Day wonder …..

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Added Benefits??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 How can I help the cause of Thalassemia?Thalassemia?

Get yourself tested for Thalassemia Minor Get yourself tested for Thalassemia Minor For care of Thalassaemia Major children For care of Thalassaemia Major children : : Donate blood regularly. Donate blood regularly. Provide financial support for Thalassemia Provide financial support for Thalassemia

patients. 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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