Effects of α-tocopherol on hemolysis and oxidative stress markers on red blood cells in β-thalassemia major

Abstract

Background: The accumulation of unpaired α-globin chains in patients with β-thalassemia major may clinically create ineffective erythropoiesis, hemolysis, and chronic anemia. Multiple blood transfusions and iron overload cause cellular oxidative damage. However, α-tocopherol, an antioxidant, is a potent scavenger of lipid radicals in the membranes of red blood cells (RBCs) of patients with β-thalassemia major.Purpose: To evaluate the effects of α-tocopherol on hemolysis and oxidative stress markers on the RBC membranes of patients with β-thalassemia major.Methods: Forty subjects included in this randomized controlled trial were allocated to the placebo and α-tocopherol groups. Doses of α-tocopherol were based on Institute of Medicine recommendations: 4–8 years old, 200 mg/day; 9–13 years old, 400 mg/day; 14–18 years old, 600 mg/day. Hemolysis, oxidative stress, and antioxidant variables were evaluated before and after 4-week α-tocopherol or placebo treatment, performed before blood transfusions.Results: Significant enhancements in plasma haptoglobin were noted in the α-tocopherol group (3.01 mg/dL; range, 0.60–42.42 mg/dL; <i>P</i>=0.021). However, there was no significant intergroup difference in osmotic fragility test results; hemopexin, malondialdehyde, reduced glutathione (GSH), or oxidized glutathione (GSSG) levels; or GSH/GSSG ratio.Conclusion: Use of α-tocopherol could indirectly improve hemolysis and haptoglobin levels. However, it played no significant role in oxidative stress or as an endogen antioxidant marker in β-thalassemia major.

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

“…Mahjoub et al 31 reported a marked reduction in malondialdehyde (MDA) concentration as an index of lipid peroxidation in erythrocytes membranes in patients with beta-thalassemia major with a mean age of around 18 following four weeks of vitamin E therapy (550/kg).In contrast, children with β-thalassemia major who were treated with vitamin E supplement with the dosage of 200-600 mg/kg/day for four weeks showed no signi cant change in MDA level or endogenous antioxidants, but a substantial effect on RBCs membrane by indirectly increasing the level of haptoglobin levels and decreasing hemolysis 25 .…”

“…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 .…”

The hidden blood loss and its factors in patients undergoing minimally invasive knee arthroscopy

“…Hemolysis can further activate oxidative stress (20), resulting in hidden blood loss (21). Prolonged surgery and blood transfusion also induce hemolysis, which is associated with the use of cardiopulmonary bypass (22) and also with oxidative cell damage (23). Transfused patients experience elevated bilirubin and decreased hemoglobin increment (24), which indicates that hemolysis is also present after transfusion, and it can also lead to hidden blood loss.…”

Use of antioxidant nanoparticles to reduce oxidative stress in blood storage

“…In blood banking conditions, the blood antioxidant system may not be able to protect the blood cells against oxidative damage by free radicals and this has a negative effect on blood quality during storage 15 . Complications of this disorder include oxidation of lipid membrane and denaturation of proteins 17 …”

“…15 Complications of this disorder include oxidation of lipid membrane and denaturation of proteins. 17 So far, there are several ways to reduce the storage of lesions in blood bags. Storage of RBCs under anaerobic conditions has been used as a way to reduce oxidative stress.…”