Role of Vitamin C Supplementation on Iron Overload and Oxidative Stress in Beta Thalassemia Major Patients in Maysan Province-Iraq

Abstract

Background: Vitamin C is a well-known powerful water soluble antioxidant and very powerful iron absorption enhancer. It was used for a long period in the management of thalassemia major (TM) patients hoping to decrease the oxidative stress initiated by iron overload resulted from hemolysis of erythrocytes and frequent blood transfusions (BT). Iron overload from BTs may be exacerbated in patients due to increased absorption of iron from the diet in response to ineffective erythropoiesis or vitamin C supplementation. Aim: To evaluate the impact of vitamin C supplementation on the iron overload and oxidative stress in beta thalassemia major patients Methods: Fifty five children were investigated in this study. Thirty two of them were patients with TM on frequent BTs and oral chelating drug (deferasirox), they were diagnosed by hemoglobin electrophoresis with a mean age of 9±4.3 y. Patients were attendees of the Blood Disease and Thalassemia center in Maysan Province-Iraq in the period between November 2013 and November 2014. Twenty three apparently healthy children with a mean age of 8±3.2 y were included as a control group. Patients were subjected to vitamin C supplementation (200mg/day) for 2 months. Serum; vitamin C, iron, malondialdehyde (MDA), ferritin and UIBC and complete blood count were determined. Results: There were significant increases of serum iron (P<0.05) and ferritin (P<0.05) levels with insignificant increase of serum MDA levels in samples of patients before supplementation when compared with those of the control groups. However, a significant decrease in serum vitamin C levels (P<0.05) and serum UIBC values (P<0.05) were evident during a similar comparison. The results of second samples, in comparison with the results of first samples referred to a statistically significant increase in serum vitamin C and serum iron (P<0.05), non-significant increase in serum ferritin and MDA and non-significant decrease in UIBC. The complete blood count remained the same in both samples. Conclusion Vitamin C is a powerful enhancer of iron absorption from GIT and releaser from intracellular stores than antioxidant agent. Vitamin C must be given with caution and continuous supervision to TM patients. Recommendation: It is essential to study both smaller and larger doses than 200mg with a longer periods and expanded age groups.