Effects of Vitamin E on Transfusion Requirements in TransfusionDependent Beta-Thalassemia Patients

Abstract

Objective: To evaluate the volume of blood transfusion requirements as well as hemolytic and oxidative biochemical variables in transfusion-dependent β-thalassemia patients supplemented with vitamin E.Material and Methods: A prospective, double-blind, randomized, placebo-controlled, crossover study was undertaken between December, 2012 and September, 2014 in the Pediatric Clinic of Songklanagarind Hospital. The participants were β-thalassemia major and Hb E/β-thalassemia patients aged between 5 and 18 years. A random allocation sequence was generated to receiving either 6 months of vitamin E or placebo followed by a 3-month washout period and then switching to another drug for 6 months. The outcome variable measurements were the volumes of the transfused packed red cells, and the hemolytic and oxidative biochemical variables.Results: Thirty-nine patients were enrolled into the study. All of them had significantly low levels of vitamin E and reduced glutathione levels, as well as high levels of oxidative stress shown by significantly high levels of malondialdehyde, superoxide dismutase, and glutathione peroxidase. The vitamin E levels became normal after the 6-month period of 200-400 milligram per day of oral vitamin E intake. All of the measured oxidative stress parameters did not improve except for the glutathione peroxidase level. Moreover, there was no difference in the volumes of transfused packed red cell requirements as well as hemolytic parameters like aspartate transaminase, lactate dehydrogenase, reticulocyte count and total bilirubin levels. Finally, no adverse reactions to oral vitamin E were found.Conclusion: Vitamin E supplementation normalized the vitamin E level and possibly partially reduced oxidative stress, but there was no difference in the volume of transfusion requirements or the hemolytic parameters in transfusion-dependent β-thalassemia patients.

The Effect of N-Acetyl Cysteine and Vitamin E on Oxidative Status and Hemoglobin Level in Transfusion-Dependent Thalassemia Patients: A Systematic Review and Meta-Analysis

“…On the other hand, the addition of another antioxidant to Vitamin E supplement [cocktails consisting of a combination of hydrophobic (Vitamin E or curcuminoids) and hydrophilic antioxidants (NAC) and an iron chelator (Deferiprone)] showed more bene cial effects on oxidative stress, hemoglobin concentration and hypercoagulable state in adult patients with non-transfusion dependent β-thalassemia/Hb E patients 30 . It seems that combination therapy compared to monotherapy and persistently high iron overloadcan partly explain the difference in clinical response among previous studies 24,29,30 .…”

“…Vitamin E is one of the most potent natural lipid-soluble antioxidants in the body. It acts as a potent scavenger of lipid radicals in the membranes of red blood cells and inhibits the propagation of free radical reactions 24,25 .…”

“…Trangsuwanet al 24 reported the successful effect of 6-month Vitamin E therapy (200-400 mg per day) in children with β-thalassemia major and Hb E/βthalassemia patients. They illustrated the possible effect of Vitamin E with 10 mg per kg daily on partially reduced oxidative stress by correcting Vitamin E level and improving in glutathione peroxidase level.…”

“…Iron excess in thalassemia patients is mainly due to transfusion iron overloadand suppressing hepcidin synthesis, a regulatory hormone produced by the liver. The suggested mechanism of suppressing hepcidin is enhanced erythropoiesis, leading to increased gastrointestinal iron absorption in these patients 32 .It is hypothesized that patients with thalassemia may poorly respond to vitamin E with inadequate improvement in oxidative biomarkers due to persistent iron overload 24 .Iron status is affected by several factors such as disease severity, the volumeand interval of blood transfusions, hepcidin synthesis, type of iron chelation therapy, and patientsć ompliance. All of these factors can consequently ameliorate oxidative stress status.…”