Ways to improve Life Expectancy in Sickle Cell Anaemia Patients using Herbs
Beatrice Y. Danladi, P. Geetha
School of Pharmaceutical Sciences, Vels Institute of Science Technology and Advanced Studies, Pallavaram, Chennai 600117-India
Sickle cell anaemia is a genetic blood disease due to the presence of an abnormal form of ‘haemoglobin S’ (the haemoglobin becomes shaped like a sickle, hence the name sickle cell anaemia). The cells eventually undergo lyses causing blockage or occlusion of the blood vessels and it leads to severe pain in the bones (this episode is called as crisis). Due to the many complications that are associated with the diseases, natural herbs such as the Annona species, clove, papaya etc. are important to keep the patient at least healthy as the use of synthetic drugs may have lots of complications and negative side effects on the patient in the long run. Synthetic drugs are also comparatively expensive to maintain continuous use since drugs are taken all through the individual’s lifetime. The patient might as well develop tolerance or incompatibilities may occur. Therefore herbs are better used since they are more like food substances, comparatively less side effects, comparatively cheap and more acceptable.
History of the disease:
Before looking at how herbs can be used and what these herbs are it is important to evaluate the disease itself. It is a disease that has eaten deeply like a canker worm into the sub-Saharan part of Africa especially Nigeria (western Africa). The disease was first identified by a hospital intern when a black medical student complained of shortness of breath, heart palpitation, abdominal pain, ache and pain in the muscle1. According to reports, Africa is believed to be the origin of sickle cell anaemia and those affected with the disease are estimated at 200000 per year1. There is a common belief in the eastern part of Nigeria called ‘ogbanje’, it actually is sickle cell anaemia but due to ignorance it used to be called as that and it was believed that they were evil children who kept dying and reincarnating.
But it is definitely that both parents have the sickle cell trait and so they give birth to children with the disease who go through the pain and crisis then die at an early or young age. The disease was first named sickle cell anaemia in the year 1922 by Verne Mason2.
NB: formation of sickle cell disease in children from parents with the trait
Normal and abnormal blood cells
Well, growing up in Nigeria with friends and family who have the sickle cell disease and watching them go through the pain and limitations of leading normal lives has inspired me to write and research about how best to increase and improve the life expectancy of these patients by herbs other than synthetic drugs. These patients are on drugs for a lifetime just to ensure they manage to live quite a normal healthy life like others. Herbal plants are abundant in nature and due to their constituents, their importance cannot be overemphasized. They contain alkaloids, flavanoids, anthraquinones, saponins, tannins, lactones, volatile oils etc. They are extracted and isolated tinctures, decoctions and concoctions, as in syrups, essential oils, ointments and creams. Being that they have these bioactive ingredients they are evaluated and used to improve life expectancy and make living more bearable for sickle cell anaemia patients.
Signs and symptoms:
Early signs and symptoms may include the following:
· Swelling of hands and feet (dactylitis) which is painful.
· Fussiness from anaemia or tiredness.
· Jaundice i.e. yellowish colour of skin or whites of the eye (icteris).
However, after closely observing the sickle cell patients around me, I discovered that they majorly have the following symptoms and clinical manifestations.
· Pain related issues
· Organ failure
The sickle cell crisis is caused by vessel occlusion, triggered by membrane deformation. Acute chest syndrome is one of the major reasons for their hospitalizations, stroke and acute splenic sequesteration also. Other symptoms and clinical manifestations are delayed growth and sexual maturation, hyposthenuria, priapism, vascular necrosis, proliferative retinopathy, aplastic crisis, cholelithiasis, chronic pulmonary disease, chronic nephropathy, jaundice etc2.
Herbs in use:
One of the major herbs is the Eugenia caryophyllus (clove). It plays a major role as antibiotic and pain relieving in the body. Eugenia caryophyllus, Piper guinense, Pterocarpus osun, and Sorghum bicolour are the herbal plants used to compound the drug NIPRISAN which is an antisickling drug. NIPRISAN has passed phases IIA and IIB and is widely used in Nigeria and is popular in India and USA. It is suggested that phytocannabinoids and villoids in E. carryophylata and P. guineense may account for some of the useful effects in sickle cell crises.
The aqueous extract of the unripe fruit of paw paw (Carica papaya) as a home remedy during crises. When the extract is kept for about 48 hours it shows its capability in inhibiting and reversing sickling of HbSS red blood cells. It was suspected that the anti-sickling compounds are organic acids released from esters during the fermentation of fruits for 48 hours.
The root extract of Zanthoxylum xanthoxyloides helps to preserve the red colour of the red blood cells. During a screen the antimicrobial activity of Zanthoxylum xantholoides, its anti sickling activity was discovered in 1979 by Sofowora et al. It also reverts sickled HbAS and HbSS and crenated HbAA red blood cells to normal in vitro3.
Cyperus esculentus (Tiger nut) is a species of sedge native to one temperate to sub tropical regions of the northern hemisphere. Consumption of the seeds regularly by sickle cells anemia patients has proved to possess anti-sickling activity4.
The extract of Pterocarpus xantholinoides and Aloe vera was reported to increase the gelling time of sickle cells blood and inhibits sickling in vitro. The plants have really shown use in managing the disease.
About 13 Congolese plants were screened for anti-sickling agents. Only 12 of them possessed such properties. These plants are, Archonea cordifolia, Afromomum alboviolaceum, Annona senegalensis, Bridelia feruginea, Celba pentandra, Morinda lucida, Hymenocardia acida,Coleus kilimandcharis, Dacryodes edulis, Cymbopogon densiflorus, Caloncoba wehvithsis and Vigna unguiculanta1.
The bark extract of Khaya senegalensis has a strong anti-sickling activity. The main active constituent was identified as a rearranged limonoid. In comparison to pentoxifylline used as standard, the in vitro anti sickling activity of this limonoid was much higher at any concentrations and incubation conditions5.
The crude extract of Kola (Garcinia kola) exhibited anti-sickling activity whilst the seed pod also. The anti-sickling properties of three plant leaf extract such as cashew, guava and Indian almond have also been reported6.
Aged garlic extract has been reported to exert an anti-oxidant effect in vitro on sickle cell RBCs. It has been shown to significantly improve erythrocytes deformability through stabilization of erythrocyte membranes in non sickle RBC due to the anti oxidant activities of aged garlic extract. It is a relatively harmless agent for the management of the sickle cell disease.
Plants from the genus Annona are actually very palatable fruits called as custard apple. These plants contain or possess anti-sickling properties. The patient can easily consume the fruit for its effect and enjoy eating the fruit.
It was seen in a Congolese study that Bombax pentadrum, Ficus capensis, Parinari mobola and Ziziphus mucronata have great antisickling activity. It is majorly due to the presence of anthocyanins. The antisickling properties of anthocyanins extracts were studied with electromagnetic radiations and were seen to have a short half life and therefore quick or faster onset of action. These extracts can be given to the patients in emergency situations7, 8.
Reservatrol which is a natural chemical extract that is mostly found in red wine and various plants and fruits, has been found to induce production of foetal haemoglobin, it decreases the sickling of red blood cells and reduces the painful vascular episodes (crises) associated with the disease. We know that the abnormal shape of the erythrocytes impedes blood passage through vessels and can cause excruciating pain and other complications because of the blood’s oxygen deficiency. Consumption of red grapes or its extract helps to prevent and manage crises so it is important as it is also palatable for children especially9.
Research has helped patients live longer, and the use of herbal plants can the increase statistics of patients who live along with the disease. In the 1970s, life expectancy for individuals with sickle cell disease was about 14 years. Today, many individuals can live into their 40s and longer10.
RELEVANCE OF THE STUDY:
In India, sickle cell trait can be seen in different areas (the Verdean tribes of the south, the tribes of western India and certain labour tribes drawn from Orissa working in the Assam tea garden)11. It was first described in the year 1952 in the Niligri Hill of Northern Tamilnadu. Extensive studies were carried out by the anthropological survey of India and the occurrence was found to be about 35% in some communities12. Due to this statistics the study is relevant in India to help alleviate the pain of affected persons and help them live longer.
Most definitely the study is also relevant and applicable to other parts of the world especially Nigeria which records about 200 000 patients yearly.
All these claims on the efficacy of medicinal plants in the management of sickle cell however have their setbacks. Some of these plants may not be direct anti-sickling agents but may indirectly contribute to ameliorate so many multiple factors inherent in sickle disease condition. The resultant effect of the actions of these plants is their ability to manage sickle cells anaemia patients. As shown earlier on by the chat, the sickle cell disease is inherited from parents who have the disease or trait by the crossing of the genes. Since the disease can almost not be avoided then herbs become important to survive. These herbs or plants are better because they are more economical and some of them are palatable as fruits or spices. Therefore life can be morebearable if patients eat these herbs regularly and build a proper diet. Less crises would occur.
My sincere gratitude goes to Mrr. P. Geetha for her continuous support, time and guidance and for believing in me. I also thank God above all.
1. Joy Okpuzor Et al. The Potential of Medicinal Plants In Sickle Cell Control; International Journal of Biomedical and Health Sciences. Volume 4 no.2 June 2008
2. Sunday J. Ameh Et al. Traditional Herbal Management of Sickle Cell Anaemia: Lessons from Nigeria. Anaemia vol.2012 Article ID:607436
3. A Egunyomi et al. Antisickling activities of two ethnomedicinal plant recipes used for the management of sickle cell anaemia. African Journal of Biotechnology vol.8(1), 020-025 2009
4. Bisu Prasad Dash Et al. Search for anti sickling agents from plants; Pharmacognosy reviews vol.7 June 2013
5. Fall A B Et al. Invitro anti sickling activity of a rearranged limonoid isolated from Khaya senegalensis.; Planta Medica 65(3):209-12 May 1999
6. Chikezie P C; Sodium metabisulphite – induced polymerisation of sickle cell haemoglobin incubated in the extract of three medicinal plants. Pharmacognosy Magazine 7(26):126-32 April 2011
7. P.T Mpiana Et al. In Vitro antidrepanocytary activity (anti-sickle cell anemia) of some Congolese plants. Phytomedicine 14 (2-3) 192-195 2007
8. P.T Mpiana Et al. Antisickling activity of anthocyanins from Bombax pentadrum, Ficus capensis and Ziziphus mucronata: Photodegradation effect. 2008 Journal of ethnopharmacology vol.120 issue3 page 413-418
9. Davies Agyekum; Red grape skin extract could be new treatment for sickle cell disease patients. 22nd October 2009: Available from: URL: http://www.eurekalert.org
10. Sickle cell disease research and care
11. N Shukla Et al. Sickle Cell Disease in India. R Blood Journal: Available from: www.bloodjournal.org
Received on 30.05.2017 Accepted on 18.06.2017
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