Is Vitamin C Supplementation Beneficial on Plasma Levels of Vitamin C and Total Anitioxidants for Pediatric Thalassemic Patients Undergoing Hematopoietic Stem Cell Transplantation?
Background: Thalassemic patients undergoing Hematopoietic Stem Cell Transplantation (HSCT) are faced with cumulative high level of oxidative stress and depletion of critical antioxidants. Administration of antioxidants, is promising towards minimizing oxidative damage in both thalassemic and HSCT patients.
Method: This was a prospective cross-sectional observational study. Patients as a part of institutional protocol were received Vitamin C (Vit C) (all the patients received oral Vit C; 200 mg and 400 mg Vit C, if they were less or more than 20 kg respectively plus 10 mg/kg/day intravenous infusion of Vit C).We measured plasma Vit C and total antioxidant (TAs) levels at four different time points; baseline, transplantation day (0), day +7 and day +14. We calculated mean and standard error for plasma levels of Vit C and TAs.
Results: Fifthy patients enrolled in this study (mean age 7.97± 3.53). In all four time points, means of Vit C and TAs serum levels were under their reference values and their highest means were belong to baseline. Serum TAs and Vit C both depleted significantly from baseline to day 0 (P: 0.00 for both variables), then increased up to day +7 and it keeps rising till day +14 (P: 0.00 from day0 to day +7 and +14 for both variables). These changes were significant through the measurement time. There is also a significant correlation between baseline Vit C and baseline TAs (P: 0.11). This means the higher level of Vit C is correlated with higher level of TAs and vice versa.
Conclusion: We did not observe any beneficial effects of administering Vit C in thalassemic patients undergoing HSCT in order to increase or prevent depletion of Vit C and TAs serum levels. This could be resolved by further investigations carrying out higher doses or longer duration and having a control group.
Weatherall DJ. Thalassemia as a global health problem: recent progress toward its control in the developing countries. Ann N Y Acad Sci 2010;1202:17-23.
Mahyar A, Ayazi P, Pahlevan AA, Mojabi H, Sehhat MR, Javadi A. Zinc and copper status in children with Beta-thalassemia major. Iran J Pediatr 2010;20(3):297-302.
Habibzadeh FYM, Merat A, Haghshenas M. Thalassemia in Iran: an overview. Arch Irn Med 1998;1:27-34.
Hajimahmoodi MH, Hamidieh A, Ahmadvand A, et al. Is Supplementation Efficacious in Maintaining Adequate Plasma Levels of Vitamin A and E for Thalassemic Patients Undergoing Hematopoietic Stem Cell Transplantation? A Cross-Sectional Study. Iranian Journal of Pediatrics 2014;24(1):35-41.
Dhawan V, Kumar Kh R, Marwaha RK, Ganguly NK. Antioxidant status in children with homozygous thalassemia. Indian Pediatr 2005;42(11):1141-5.
Sabuncuoglu S, Kuskonmaz B, Uckun Cetinkaya D, Ozgunes H. Evaluation of oxidative and antioxidative parameters in pediatric hematopoietic SCT patients. Bone Marrow Transplant 2012;47(5):651-6.
Goncalves TL, Benvegnu DM, Bonfanti G, Frediani AV, Pereira DV, Rocha JB. Oxidative stress and delta-ALA-D activity in different conditioning regimens in allogeneic bone marrow transplantation patients. Clin Biochem 2009;42(7-8):602-10.
Evens AM, Mehta J, Gordon LI. Rust and corrosion in hematopoietic stem cell transplantation: the problem of iron and oxidative stress. Bone Marrow Transplant 2004;34(7):561-71.
Bazvand F, Shams S, Borji Esfahani M, et al. Total Antioxidant Status in Patients with Major β-Thalassemia. Iran J Pediatr 2011;21(2):159-65.
Britton RS, Leicester KL, Bacon BR. Iron toxicity and chelation therapy. Int J Hematol 2002 ;76(3):219-28.
Tavazzi D, Duca L, Graziadei G, Comino A, Fiorelli G, Cappellini MD. Membrane-bound iron contributes to oxidative damage of beta-thalassaemia intermedia erythrocytes. Br J Haematol 2001;112(1):48-50.
Şimşek F, Öztürk G, Kemahlı S, Erbaş D, Hasanoğlu A. Oxidant and antioxidant status in beta thalassemia major patients. Journal of Ankara University Faculty of Medicine 2005;58(1):34-8.
Muscaritoli M, Grieco G, Capria S, Iori AP, Rossi Fanelli F. Nutritional and metabolic support in patients undergoing bone marrow transplantation. Am J Clin Nutr 2002;75(2):183-90.
Livrea MA, Tesoriere L, Pintaudi AM, et al. Oxidative stress and antioxidant status in beta-thalassemia major: iron overload and depletion of lipidsoluble antioxidants. Blood 1996;88(9):3608-14.
Dissayabutra T, Tosukhowong P, Seksan P. The benefits of vitamin C and vitamin E in children with beta-thalassemia with high oxidative stress. J Med Assoc Thai 2005;88 Suppl 4:S317-21.
Jonas CR, Puckett AB, Jones DP,et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72(1):181-9.
Sies H, Stahl W. Vitamins E and C, beta-carotene, and other carotenoids as antioxidants. Am J Clin Nutr 1995;62(6 Suppl):1315S-21S.
Cakmak A, Soker M, Koc A, Aksoy N. Prolidase activity and oxidative status in patients with thalassemia major. J Clin Lab Anal 2010;24(1):6-11.
Rund D, Rachmilewitz E. New trends in the treatment of beta-thalassemia. Crit Rev Oncol Hematol 2000;33(2):105-18.
White AC, Sousa AM, Blumberg J, Ryan HF, Fanburg BL, Kayyali US. Plasma antioxidants in subjects before hematopoietic stem cell transplantation. Bone Marrow Transplant 2006;38(7):513-20.
Copyright (c) 2015 Journal of Pharmaceutical Care
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.