Antioxidant vitamins C and E supplementation increases markers of haemolysis in sickle cell anaemia patients: a randomized, double-blind, placebo-controlled trial

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Arruda, Martha M. [UNIFESP]
Mecabo, Grazielle [UNIFESP]
Rodrigues, Celso A. [UNIFESP]
Matsuda, Sandra S. [UNIFESP]
Rabelo, Iara B. [UNIFESP]
Figueiredo, Maria S. [UNIFESP]
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Erythrocytes from sickle cell anaemia (SCA) patients continuously produce larger amounts of pro-oxidants than normal cells. Oxidative stress seems to primarily affect the membrane and results in haemolysis. the use of antioxidants in vitro reduces the generation of pro-oxidants. To evaluate the impact of vitamins C (VitC) and E (VitE) supplementation in SCA patients, patients over 18years were randomly assigned to receive VitC 1400mg+VitE 800mg per day or placebo orally for 180d. Eighty-three patients were enrolled (44 vitamins, 39 placebo), median age 27 (1868) years, 64% female. There were no significant differences between the two groups regarding clinical complications or baseline laboratorial tests. Sixty percent of the patients were VitC deficient, 70% were VitE deficient. Supplementation significantly increased serum VitC and E. However, no significant changes in haemoglobin levels were observed, and, unexpectedly, there was a significant increase in haemolytic markers with vitamin supplementation. in conclusion, VitC+VitE supplementation did not improve anaemia and, surprisingly, increased markers of haemolysis in patients with SCA and S-0-thalassaemia. the exact mechanisms to explain this findings and their clinical significance remain to be determined.
British Journal of Haematology. Hoboken: Wiley-Blackwell, v. 160, n. 5, p. 688-700, 2013.