So, we may safely assume that thalassemia sufferers are fatigued due to thalassemia.
But what would be the cause of that fatigue?
By finding what the causes are, we could convince doctors, researchers and other people
once and for all that this fatigue is real.
Of course in case of thalassemia major and intermedia the situation is a bit different – there is
additonal iron overload, ROS production etc. These mechanisms do not apply to thalassemia
As far as I can figure out:
1. Vitamin depletion.
Because of continuous production of erythrocytes different vitamins get used up faster than in “normal” people. Consecutive deficiency causes fatigue as different parts of body do not work
as they should and get fatiqued.
Vitamin deficiency can be easily alleviated by taking supplements (especially vitamins B complex)
2. Underoxygenation of tissues.
With unsufficient oxygen supply tissues do not have energy and experience different other problems, for example acidification.
But in case of sufficient hemoglobin (mine is 15,3 g/dl) underoxygenation should not be a problem, or is it?
Obvious solution to this problem is bringing hemoglobin to normal level (which may not be easy), taking antioxidants (they stop erythrocyte breakdown so they help increase hemoglobin) and taking vitamin E which makes blood thinner and erytrhocytes more flexible allowing better penetration of tissues.
Acidification may be fought by eating fruit or taking baking soda/sodium citrate.
3. Provoking inflammation/releasing different substances signalling brain that fatigue should be felt.
It is feasible that after erythrocytes break down there are certain substances released that cause inflammation (cytokines). Also the intracellular machinery may be somehow detected and this signals the brain to stop activity by inducing fatigue (strain -> broken cells -> necessity to stop the strain).
For example muscle cells release additionally endorphines, which cause this pleasant feeling of relaxation but also make you tired and a little dizzy.
Anyone has any idea of specific substance that can be released by erythrocytes breaking down?
4. Other disorders caused by thalassemia minor like allergies.
Well, as a matter of fact I think thalassemia’s involvement in causing other disorders is highly overrated but I mention it for the sake of the accuracy (I read such a statement in one of the threads). However my personal opinion is that simply all people get sicker due to pollution etc.
5. Bone pain.
Bone pain caused by bone marrow overproduction.
6. Heme/hemoglobin conundrum…
The first four items are kind of well recognized, this one is purely speculative.
This is the kind of question that can be answered probably only by a doctor/geneticist. If you are one or have a contact with one, you might want to pursue this question.
So I was wondering…
In case of beta-thalassemia (or alpha-thalassemia) one of hemoglobin chains is damaged.
Is it possible that this hemoglobin chain is used in different locations within the body?
Damaged hemoglobin in different locations would lead to impaired function and that would lead to fatigue (and other problems).
Possible different locations of hemoglobin:
– myoglobin in muscles
– complex III in electron transport chain
– complex IV (cytochrome c oxidase) in electron transport chain
– cytochrome c in electron transport chain
The question is if any parts of these compounds are expressed by the same genes as a particular hemoglobin? If so, we may have the answer.
This all gets even more complicated because of heme which is encoded by a different gene.
If it is the heme that is a common part of the above compounds, one would rather have porphyria and not thalassemia.
All in all this is all quite complicated (and I am not describing this correctly, I know) and a person is needed that knows exactly which part of the given compound is coded by a particular gene.
Why this kind of idea?
I have beta-thalassemia minor but I also have (metabolic) myopathy.
This means erythrocytes break down but also muscle cells break down. This is weird – it is much more likely that these two are interconnected somehow than they are not. So it is likely that the cause is the same for both of these disorders. So I am looking for this connection but I can’t find any.
This kind of connection in general might cause fatigue.