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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 8  |  Issue : 2  |  Page : 97-100

Ayurvedic add-on therapy for β-Thalassemia major cases on quality of life: A case series


1 Hospital Division, Central Ayurveda Research Institute, Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Government of India, Kolkata, India
2 Department of Statistics, Central Council for Research in Ayurvedic Sciences, New Delhi, India
3 Regional Ayurveda Research Centre (CCRAS, New Delhi), Agartala, Tripura, India
4 Department of Chemistry, CARI, Kolkata, West Bengal, India

Date of Submission25-Jun-2021
Date of Decision24-Nov-2021
Date of Acceptance25-Nov-2021
Date of Web Publication29-Jun-2022

Correspondence Address:
Achintya Mitra
Central Ayurveda Research Institute, 4 CN Block Sector V, Bidhan Nagar, Kolkata - 700 091, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AYUHOM.AYUHOM_36_21

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  Abstract 


Blood transfusions which were suggested as treatment for beta thalassemia major cases brought down the quality of life by several means like splenomegaly, growth retardation, poor appetite, low hemoglobin (Hb), increased serum ferritin level, etc. In present study the group of 79 patients which were selected were having such symptoms arouse due to repeated conventional blood transfusion. the patient was given Amlavetas (Garcinia pedunculata Roxb. ex Buch. Ham) dry fruit pulp (5 g) once daily in the early morning on an empty stomach regularly for 6 months without imposing any restriction to their regular food and other medicines for his existing comorbidities. Objective parameters such as Hb (g%), body weight (Kg), loss of appetite serum ferritin (ng/dl), and frequency of blood transfusion were assessed which ultimately help to understand the QoL of the subjects. The Hb percentage after 3rd month and 6th month was 6.94 ± 1.57 g% and 6.99 ± 1.52 g% which were significant when compared with baseline values (6.42 ± 1.37 g%, P < 0.001). The serum ferritin was significantly increased (P < 0.005) in the follow up visits when compared with baseline value 3112.13 ± 2801.20 ng/dl. The gain in body weight, increase in appetite and reduced blood transfusion rate indicates the quality of life, revealed by the improvement of his blood parameters including the serum ferritin level. Amlavetas fruit pulps can be a potential iron chelating as well as erythropoiesis Ayurvedic intervention to normalize iron metabolism, relieve thalassemia symptoms, and increase BT intervals with better life expectancy.

Keywords: Amlavetas fruit, beta-thalassemia major, Garcinia pedunculata


How to cite this article:
Mitra A, Tripathi A, Ravte RK, Hazra K, V. Prasad P V. Ayurvedic add-on therapy for β-Thalassemia major cases on quality of life: A case series. AYUHOM 2021;8:97-100

How to cite this URL:
Mitra A, Tripathi A, Ravte RK, Hazra K, V. Prasad P V. Ayurvedic add-on therapy for β-Thalassemia major cases on quality of life: A case series. AYUHOM [serial online] 2021 [cited 2022 Nov 27];8:97-100. Available from: http://www.ayuhom.com/text.asp?2021/8/2/97/348858




  Introduction Top


Thalassemia is a genetic disorder of hemoglobin (Hb) synthesis that results from an alteration in the rate of globin chain production wherein genetic defect results in reduced rate of synthesis or no synthesis of one of the globin chains that makes up Hb. This causes the development of abnormal Hb molecules, therefore causing anemia, the characteristic symptom of the disease.[1] It is estimated that about 1.5% of the world population (80–90 million people) are carriers of beta-thalassemia, with about 60,000 symptomatic individuals born annually. The total annual incidence is estimated at 1 in 1 lakh globally and 1 in 10,000 people in the European Union.[2],[3]

Thalassemia is not exactly mentioned in the classical Ayurveda by today's nomenclature but based on its disease pathological and clinical understanding, it may be correlated with Beejadoshajanya, Adibalapravritta, and Sahaja Vyadhi. Finally, it may be considered Beejadustijanya Panduroga. The process of formation of Raktadhatu is being affected due to tainted Pittadosa in the case of Sahaja cause.[4]

The genetic basis of various diseases was known to ancient Acharyas. They described the possible cause of Beejadushti or defected mutation and also indicated the possible consequences in the form of Tridosha Prakopa or vitiation of body humors, Vikrita Avayava or defected organ formation corresponding to biochemical abnormalities or functional abnormalities and structural defects related to Upatapti of Beeja or Beejabhaaga which are Asadhya or incurable in nature.[5] Acharya Charaka described Beejadushtijanya Vikaras, wherein he explained that specific Avayava (organ) would be Vikrita (defected) if Doshas (humors) vitiate specific Beeja (sperm or ovum) or Beejabhaaga (chromosomes).[6]

In beta-thalassemia major, frequent blood transfusion severely jeopardized quality of life (QoL) of patients, and its frequent use can lead to iron overload, causing further complications and requiring additional chelation therapy, which is costly affairs and also toxic for prolonged use. The fruits of Garcinia pedunculata Roxb. ex Buch.-Ham. (Guttiferae family, usually known as Amlavetasa) is used in Ayurveda to balance Kapha and Vata Doshas and increase Pitta Dosha.[7],[8] Hence, Amlavetasa dry fruit pulp to a series of β-thalassemia major patients was advocated with the main aim of improving his Hb g%, reduction of serum ferritin level in the blood, increasing BT intervals, and ultimately comprehensively improvement of QoL.


  Presenting Concerns Top


The series of diagnosed cases of β-thalassemia major children of age groups of 6 years to 14 years depend on blood transfusion in regular intervals along with standard medication by the tertiary health-care centers. The common clinical symptoms were pallor, general weakness, fatigue, poor appetite, growth retardation, and shortness of breathing (SOB) in exaggeration whereas reported blood transfusion in regular intervals was used to survive and well-being. They had the proper prescriptions, diagnosis reports, and blood transfusion card and reported at the Outpatient Department (OPD), Central Ayurveda Research Institute, Bidhannagar, Kolkata, India.


  Clinical Findings Top


Seventy-nine diagnosed cases of β-thalassemia major were attended to OPD of Central Ayurveda Research Institute, Kolkata, with the chief complaints of weakness, SOB, pallor, growth retardation, splenomegaly, and poor appetite with regular and frequent undergone of blood transfusion. All cases belong to 6 years to 14 years of age group and were diagnosed by medical colleges through Hb electrophoresis method and confirmed by producing the report and treatment card, and transfusion sheet during the examination. This retrospective study was carried out during the period of 2018–2019.

The vital parameters on general physical examination, i.e., height, body weight, body mass index, pulse beats/min, body temperature, blood pressure, and respiratory rate-breaths/min were recorded. Per abdomen examination such as palpable liver and spleen were palpable and or tenderness was recorded. Other clinical findings were also examined. The specific objective parameters such as Hb (g%), body weight (Kg), serum ferritin (ng/dl), and frequency of blood transfusion were considered for the assessment of the result. All the investigation reports were checked through time to time during follow-up visits.


  Diagnostic Focus and Assessment Top


Based on confirmation and our physical examination, essential investigations of the patients were analyzed on 1st day of his visit to Central Ayurveda Research Institute, Kolkata for baseline record on the objective parameters such as Hb (g%), body weight (Kg), serum ferritin (ng/dl), and frequency of blood transfusion (per month). The baseline mean values of Hb recorded as 6.42 ± 1.37 g%, serum ferritin was 3112.13 ± 2801.20 ng/dl, body weight was 24.29 ± 11.74 kg, and frequency of blood transfusion per month was 1.48 ± 0.65 units. There were follow-up visits after 3rd month and 6th month [Table 1]. The Hb percentage after 3rd month and 6th month were 6.94 ± 1.57 g% and 6.99 ± 1.52 g% which were significant when compared with baseline values (P < 0.001). The body weight in kg was increased after 3rd month and 6th month (24.25 ± 11.50, 25.23 ± 12.86) which were significant when compared with baseline values. The serum ferritin after 3rd month and 6th month were 1653.77 ± 1716.45 ng/dl and 1469.55 ± 839.99 ng/dl which were significant when compared with baseline values (P < 0.005). The frequency of blood transfusion (per month) had significantly reduced in the consequent visit after 3rd month and 6th month, respectively as 0.98 ± 0.41unit and 0.95 ± 0.39 unit (P < 0.005) per month [Figure 1].
Figure 1: Frequency of blood transfusion at baseline and end of 6 months

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Table 1: Parameters during treatment

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  Therapeutic Focus and Assessment Top


The patient was given dry pulp of Amlavetas fruits which were identified and authenticated by the Botanical Survey of India, Kolkata and Department of Pharmacognosy, CARI, Kolkata where voucher specimen is kept. The children were advised to soak the fruit pulp in water for overnight and consume the resultant paste (5 g) once daily in the early morning on an empty stomach regularly for 6 months. The patients were not advised to follow any specific Pathya-Apathya (food constraints) during the scheduled treatment period. They were allowed to take other medicines which they were being advised. Generally, the known cases of β-thalassemia major were being treated with frequent blood transfusion, iron-chelating agents, folic acids, calcium supplements, etc.


  Follow-Up and Outcomes Top


During the first follow-up of 6 months, it was observed that the clinical symptoms such as weakness as well as fatigue and SOB are improved along with an increased appetite. The requirement for BT was gradually decreased month by month. The blood test reports revealed substantially increased Hb g%, body weight, and decreased values of serum ferritin gradually.

The entire treatment period with Amlavetasa fruit pulp was without any unintended and noxious events. Overall, his QoL improved clinically which was supported by laboratory reports and physical examinations.


  Discussion Top


Treatment modalities of β-thalassemia major depend on disease type, risk group, and patient conditions and include supportive care (for low-risk patients), growth factors, iron-chelating agents, splenectomy, and BT in a regular manner. Most of these treatment options are expensive and inconvenient, intensive, have side effects, and reduce the life quality of patients. The entire subject had to way out to repeated BT that led to a significant rise in his serum ferritin level, as observed in our biochemical assay on the baseline reporting to our center. In the present retrospective study, it was recorded that the patients were advised at OPD level to consume Amlavetas fruit pulp every morning for 6 months that led to the progressive improvement of the blood parameters including the serum ferritin level. There was made with the hypothesis that probably Amlavetasa acts as an iron-chelating agent in the managing of β-thalassemia (Hb E Disease) and improves the QoL by increasing the gap of blood transfusion.[9] Most importantly, the requirement of BT was gradually reduced during the treatment period resulting improved QoL.

This retrospective observation revealed the excellent effect of an Ayurvedic intervention (Amlavetas) without any adverse event so far. It can be used as an iron-chelating as well as hematinic agent, as the fruit pulp helps to normalize iron metabolism, prolong RBCs lifespan, relieve signs and symptoms of the β-thalassemia major, and increase BT intervals. All these factors may increase the life expectancy and provide an improved QoL of the known cases of β-thalassemia major. However, the detailed study on the characterization of the test drug and control clinical trial at par GCP guidelines following all mandatory provisions such as ethical clearance and CTRI registration should be carried out to draw the final conclusion.


  Conclusion Top


Amlavetas (Garcinia pedunculata Roxb. ex Buch.-Ham) fruit pulps has established its potential iron-chelating and erythropoietin properties when therapeutically intervened as add-on in the series of β-thalassemia major cases with blood transfusion and iron-chelating treatment. This Ayurvedic intervention has normalized iron metabolism, relieve thalassemia symptoms, and increased BT intervals, and increased quality and expectancy of the patients without any reported ADRs/ADEs. This preliminary case series has revealed the hope of ray and expecting detailed clinical study with more scientific evidence.

Acknowledgments

Authors are thankful to the trial subject for his willingness and Assistant Director In-charge, Regional Ayurveda Research Institute, Guwahati for providing the test drug.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ghai OP, Paul VK, Bagga A. Ghai Essential Pediatrics. 7th ed. New Delhi; CBS Publishers; 2010. p. 307.  Back to cited text no. 1
    
2.
Vichinsky EP. Changing patterns of thalassemia worldwide. Ann N Y Acad Sci 2005;1054:18-24.  Back to cited text no. 2
    
3.
Galanello R, Origa R. Beta-thalassemia. Orphanet J Rare Dis 2010;5:11.  Back to cited text no. 3
    
4.
Goswami A, Aagarwal S, Rajagopala S, Kori VK, Patel KS. Ayurvedic management of Thalassemia Major – A review of clinical researches conducted at IPGT & RA, Jamnagar. Int J Ayurvedic Med 2015;6:64-73.  Back to cited text no. 4
    
5.
Vagbhatta. Ashtanga Hridaya. Nidana Sthana; Arsh. Ch. 7., Ver. 6-7. Varanasi: Chaukhambha Surabharti Prakashana; 2009. P. 477.  Back to cited text no. 5
    
6.
Agnivesha. Charaka Samhita. Sharira Sthana; Mahatigarbhavkranti. Ch. 4, Ver. 31. Varanasi: Chaukhambha Sanskrita Samsthana; 2005. p. 877.  Back to cited text no. 6
    
7.
Caraka Samhita. Sutrasthana. SadVirechana Shatashriteeya Adhyaya. Ch. 4., Ver. 10. Available from: https://easyayurveda.com/2013/11/11/charak-samhita-sutrasthana-4-shad-virechana-shatashriteeya-adhyaya. [Last accessed on 2021 Nov 17].  Back to cited text no. 7
    
8.
Sharma PV. Dravyaguna-Vijnana. Vol. II. Varanasi: Chaukhamba Bharati Academy; 2012. p. 338.  Back to cited text no. 8
    
9.
Ray C, Mitra A, Ravte RK, Hazra J. Role of Amlavetasa (Garcinia pedunculata Roxb. ex Buch.-Ham.), an Ayurvedic drug in E-ß Thalassaemia: A case study. Indian J Tradit Knowl 2018;17:598-601.  Back to cited text no. 9
    


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Abstract
Introduction
Presenting Concerns
Clinical Findings
Diagnostic Focus...
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