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Antioxidant nutrients and hemolysis in sickle cell disease

•There are some clues that antioxidants reduce the process of hemolysis.•Omega-3 fatty acids seem to be able to reduce hemolysis in sickle cell disease.•Efficacy of antioxidants in reducing hemolysis should be more explored. Hemolysis is one of the main pathophysiological characteristics of sickle c...

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Published in:Clinica chimica acta 2020-11, Vol.510, p.381-390
Main Authors: Delesderrier, Emília, Curioni, Cíntia, Omena, Juliana, Macedo, Catarina Reis, Cople-Rodrigues, Cláudia, Citelli, Marta
Format: Article
Language:English
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Summary:•There are some clues that antioxidants reduce the process of hemolysis.•Omega-3 fatty acids seem to be able to reduce hemolysis in sickle cell disease.•Efficacy of antioxidants in reducing hemolysis should be more explored. Hemolysis is one of the main pathophysiological characteristics of sickle cell disease (SCD) and might cause or could be the result of oxidative stress. Antioxidants are studied in SCD due to their potential to ensure redox balance and minimize deleterious effects on erythrocyte membranes. The objective of this systematic review was to evaluate the efficacy of antioxidant nutrient supplementation on reducing hemolysis in SCD patients through randomized clinical trials. We conducted our study according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses and the Cochrane Handbook for Systematic Reviews of Interventions investigating whether antioxidants could improve the hemolytic status of SCD patients. This study included 587 articles published until April 2020. We reduced this pool to 12 articles by excluding duplicates, reviews, comments, and studies with non-human subjects. Omega-3 fatty acids, vitamin A, and zinc were the antioxidants that reportedly improved the indirect hemolysis parameters such as hemoglobin, hematocrit, mean corpuscular volume, or red blood cells. High-dose vitamin C and E supplementation worsened hemolysis, causing increased reticulocytes, lactate dehydrogenase, indirect bilirubin, and haptoglobin. More intervention studies especially high-quality controlled randomized clinical trials are needed to investigate the effects of antioxidant nutrients in reducing hemolysis in SCD.
ISSN:0009-8981
1873-3492
DOI:10.1016/j.cca.2020.07.020