Use of Hydroxyurea with wheatgrass in Thalassaemia Major/Intermedia Dr Dr Vijay Ramanan ; MD, DM(Clinical Hematology) Introduction B-thalassaemia is caused by mutations in the β-globin locus resulting in loss of or reduced hemoglobin A ( HbA, α2β2) production. Hydroxyurea, an antimetabolite, is a potent inducer ofHbF production. Mechanisms: 1. A cytotoxic effect resulting in stress erythropoiesis, with increased HbF levels occurring as a result, is most commonly proposed. 2. More-complex effects involving the production of nitric oxide and the soluble guanylyl cyclase and cyclic guanosine monophosphate– dependent protein kinase pathway gene have been proposed as being responsible for this activity. Hydroxyurea therapy is not associated with considerable or steady effects on erythrocyte deformability in β- thalassemia, which may explain the reduced response to the drug in some patients. Wheatgrass contains Chlorophyll which makes up >70% of the solid content of wheat grass juice. Both chlorophyll and hemoglobin share a similar atom structure. Hemoglobin consists of iron, while in chlorophyll the metallic atom is magnesium. The believers of alternative system of medicine claim that as chlorophyll and hemoglobin are alike in atom structure, intake of wheat grass juice enhances hemoglobin production. The treatment of transfusion dependent b-thalassemia imposes a considerable burden on the family and institutional resources. In economically challenged nations, basic management(red cell transfusions, iron chelation) is a distant dream for the majority, who, consequently, endure a poor quality of life. Aims and Objectives: