Decreased hemolysis following administration of antioxidant--fermented papaya preparation (FPP) to a patient with PNH
Hussam Ghoti & Hanna Rosenbaum & Eitan Fibach & Eliezer A. Rachmilewitz
A 36-year old woman was diagnosed in 1996 with PNH complaining of generalized weakness and recurrent episodes of nocturnal hemoglobinuria. The diagnosis was confirmed by Ham's test and flow cytometry. The patient received folic acid, iron supplement, and danazol without significant change in her average Hb level which was ~7.5 gm/dl with LDH ~2500 u/lit. Before receiving FPP, she had anemia (Hb=7.4 gr/dl, MCV 95 fl), leukopenia (leukocyte (WBC)=1500/mcl), lactate dehydrogenase (LDH) up to 5300 u/l, indirect bilirubinemia, and elevated plasma Hb (Fig. 1). Serum haptoglobin was undetectable, serum ferritin and transferrin saturation were low, 7 ng/ml and 5%, respectively. A recent bone marrow disclosed erythroid hyperplasia.
FPP supplied as sachets, containing 3 g powder, by Osato Research Institute, Gifu, Japan, was given three times daily for 4 months. Following FPP therapy, Hb level increased by 1 gr/dl, WBC to 3,200 per microliter, and all the hemolytic parameters have been significantly improved (Fig. 1). Malondialdehyde levels, a product of lipid membrane peroxidation, were significantly decreased--which may reduce its mutagenic and leukemogenic effect. The patient was symptomatically improved, with less fatigue and better performance.
The findings indicate a significant amelioration of hemolytic and oxidative stress parameters which was induced and sustained by FPP treatment in a patient with PNH. Antioxidants may serve as inexpensive adjuvant or alternative therapy in PNH.
Fig. 1 Changes in Hb levels, WBC, and in hemolytic and oxidative stress parameters induced and maintained for 3 months following during administration of FPP
Ann Hematol (2010) 89:429-430
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