Mar 27, 2008 - Correspondence and Reprint requests : Dr Dharma R ... Dharma R Choudhary, Rahul Naithani, Inusha Panigrahi, Rajat Kumar, Manoranjan ...
Original Article
Effect of Wheat Grass Therapy on T ransfusion Requirement in β-Thalassemia Major Dharma R Choudhary, Rahul Naithani, Inusha Panigrahi, Rajat Kumar, Manoranjan Mahapatra, Hara Prasad Pati, Renu Saxena and Ved P Choudhry Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
ABSTRACT Objective. To assess the efficacy of wheat grass juice on transfusion requirement in patients with β-thalassemia major. Methods. Fifty-three patients of β-thalassemia major with a median age of 16 years were given wheat grass juice tablets. Results. The Mean pre and post wheat grass therapy, the pack cell requirement was 288.06 + 53.25 gm/Kg/year and 301.25 + 54.86 gm/Kg/year (p =0.054) respectively. No adverse effects were noted. Conclusion. We conclude that wheat grass therapy for one year is not effective in reducing the transfusion requirement in transfusion dependent thalassemia. [Indian J Pediatr 2009; 76 (4) : 375-376] E-mail: dr_drchoudhary@ yahoo.com
Key words: Thalassemia; Wheat grass therapy
Thalassemia major (TM) requires life long blood transfusion to sustain adequate hemoglobin level and iron chelation unless bone marrow transplantation (BMT) is done. BMT has its own limitations related to donor availability. Various agents have been tried to reduce transfusion requirement including hydroxyurea, butyrate and azacytidine.1 However, no consistent therapeutic response pattern has been identified in patients with TM. There is continuous search for harmful non-toxic and cost effective agents to decrease transfusion requirement as well as increase in baseline hemoglobin in patients with thalassemia. Marwaha et al 2 reported favorable responses of freshly prepared wheat grass juice extracted from pulp of wheat grass in decreasing transfusion requirement in thalassemia major. Possible mechanism proposed was structural homology between chlorophyll and hemoglobin. This study was planned using fixed dose of wheat grass tablets to assess the efficacy of wheat grass therapy (WGT) in reducing transfusion requirement in thalassemia major.
Correspondence and Reprint requests : Dr Dharma R Choudhary, Clinical Hematologist and Bone Marrow Transplant Physician, BL Kapoor Memorial Hospital, New Delhi, India. [DOI–10.1007/s12098–009–0004–6] [Received March 27, 2008; Accepted June 30, 2008]
Indian Journal of Pediatrics, Volume 76—April, 2009
MATERIAL AND METHODS Fifty-three patients of known thalassemia major attending day care center of department of Hematology, AIIMS, for regular blood transfusion therapy were enrolled in this study. Patients were selected through a computer generated random number table. All patients were subjected to detail clinical evaluation, complete blood count (pre-transfusion), serum ferritin assay, liver and renal function test, hemoglobin HPLC (HbF level), HbF cells, red cell survival study. Patients with associated hemoglobinopathies, hypersplenism or, on hydroxyurea therapy were excluded. Patients with thalassemia major are transfused at regular intervals to keep pretransfusion hemoglobin level above 9 g/dl. They are chelated with deferiprone or desferioxamine to keep serum ferritin below 1000ng/ml. However, most of the patients were receiving deferiprone due to cost considerations and that too irregularly. Patients received wheat grass tablets (500 mg tablet) in the dose of 100mg/Kg in divided doses per-orally and dose was increased to 200 mg/Kg/day if no response at the end of 6 months of therapy. The total period of study was 1 year. No detectable iron was found in wheat grass tablets by Photo-Automatic Absorption method. Response criteria were a decrease in transfusion requirement by 25% or more after institution of therapy. Statistical analyses were done by paired t- test. P value of 40% decrease in requirement of blood transfusion. The major criticism of the study was that of the 38 enrolled patients only 16 were analysed. It is possible that most of the dropouts were due to lack of response. The mean age was 13.3 years and median duration of wheat grass juice intake was 19 months - 28 months in responders and 22.5 months in nonresponders(calculated from table). In the present study, median age was 16 years and the duration of wheat grass juice intake was 12 months. It is possible that longer time is required for wheat grass juice to take effect and that older children respond lesser to this therapy. The major limitation of present study is the shorter duration of follow up. In our study, there was no difference in annual packed red blood cell requirement. The slight increase in transfusion interval in our patients is due to larger volume received during previous transfusion. Since there was no controlled population and in the study the patient’s serves as own control, it is difficult to conclude that wheat grass therapy resulted in adverse outcome. Patients with thalassemia major may require increased amount of blood during growth spurt, at time of puberty and when hypersplenism sets in. The transfusion interval may reduce at the time of intercurrent illness and with hypersplenism. The present study conclude that wheat grass therapy for one year is not effective in reducing the transfusion requirement in transfusion dependent thalassemia.
REFERENCES 1. Higgs DR, Thein SL, Woods WG. The physiology of the thalassemias. In Weatherall DJ, Clegg B, eds. The Thalassemia syndromes, 4th ed. Oxford; Blackwell Science Ltd, 2001:265-284. 2. Marwaha RK, Bansal D, Kaur S, Trehan A. Wheat grass juice reduces transfusion requirement in patients with thalassemia major: a pilot study. Indian Pediatrics 2004, l 41: 716-720 3. Bradai M, Abad MT, Pissard S, Lamraoui F, Skopinski L, de Montalembert M. Hydroxyurea can eliminate transfusion requirements in children with severe beta thalassemia. Blood 2003; 102:1529-1530. 4. de Paula EV, Lima CSP, Arruda VR, Alberto FL, Saad STO, Costa FF. Long term hydroxyurea therapy in beta thalassemia patients. Eur J Haematol 2003; 70:151-151. 5. Ben-Arye E, Goldin E, Wqengrower D, Stamper A, Kohn R, Berry E. Wheat grass juice in the treatment of active distal ulcerative colitis: a randomized double-blind placebocontrolled trial. Scand J Gastroenterol 2002; 37: 444-449. 6. Garami M, Schuler D, Babosa M, Borgulya G, Hauser P, Muller J et al. Fermented wheat germ extract reduces chemotherapy-induced febrile neutropenia in pediatric cancer patients. J Pediatr Hematol Oncol 2004; 26: 631-635.
Indian Journal of Pediatrics, Volume 76—April, 2009
