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with haematomas developing at the puncture sites&#44; and a lengthening of the haemostasis time of more than 2<span class="elsevierStyleHsp" style=""></span>h&#44; with bleeding at home and a need for referral to the emergency department on multiple occasions&#44; the dialysis parameters were adjusted to use a technique without heparin&#44; antiplatelet therapy was suspended and heparin sealing of the CVC was minimised&#46; However&#44; the increased haemostasis times persisted&#44; and there were also spontaneous bleeding episodes due to the lAVF at her home&#46; A fistolugram was performed with normal results&#46; In the laboratory tests&#44; an altered prothrombin time &#40;PT&#41; of 63<span class="elsevierStyleHsp" style=""></span>s and an activated partial thromboplastin time &#40;aPTT&#41;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>140<span class="elsevierStyleHsp" style=""></span>s were observed&#46; No underlying liver disease was revealed&#44; and the patient was not taking oral anticoagulants&#46; In light of this finding&#44; the patient was questioned again&#46; She reported taking turmeric infusions on a daily basis in quantities of 3&#8211;5<span class="elsevierStyleHsp" style=""></span>g&#46; We decided to suspend these infusions after reviewing the literature which mentions a possible anticoagulant effect&#44; as well as boosting the effects of antiplatelet therapy&#46; After 2 weeks of not using the lAVF and of abstaining from the turmeric infusions&#44; normal clotting times were displayed and the lAVF punctures were started again with no new haemorrhage incidences being presented until now&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Turmeric &#40;<span class="elsevierStyleItalic">Curcuma longa</span>&#41; is native to south-west India&#46; It is a herbaceous perennial plant from the Zingiberaceae family&#46; The most important chemical components of turmeric are a group of compounds called curcuminoids &#40;curcumin or diferuloylmethane&#44; demethoxycurcumin and bisdemethoxycurcumin&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> It also contains volatile oils such as turmerone&#44; atlantone and zingiberene&#44; as well as sugars&#44; proteins and resins&#46; Curcumin is responsible for its yellow colouring&#46; Turmeric is used routinely as a spice&#44; especially in Indian cuisine&#44; and as a food colouring&#46; Turmeric is now also used as a textile dye&#44; and it is used to dye wool&#44; cotton&#44; silk&#44; leather&#44; waxes&#44; stains&#44; etc<span class="elsevierStyleItalic">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> A wide range of biological and pharmacological activities of turmeric has been researched&#46; These include antioxidant&#44; anti-inflammatory&#44; antiviral&#44; antifungal&#44; hepatoprotective&#44; anti-cancer&#44; antimicrobial&#44; cardiovascular&#44; gastrointestinal&#44; nephroprotective&#44; anticoagulant and anti-diabetic effects&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Curcumin may bind to heavy metals such as cadmium and lead&#44; reducing their toxicity&#46; It also acts as an inhibitor of cyclooxygenase&#44; 5-lipoxygenase and glutathione <span class="elsevierStyleItalic">S</span>-transferase&#44; which converts it into an antioxidant&#44; like vitamins C&#44; E and beta-carotene&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The anti-inflammatory action of turmeric is probably due to a reduction in histamine production and also due to the fact that it increases and prolongs the action of cortisol&#46; Turmeric acts by stimulating bile production&#44; improving fat metabolism&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Pharmacokinetic studies in animals<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> have demonstrated that 40&#8211;85&#37; of oral curcumin passes through the gastrointestinal tract without changes&#44; the rest being absorbed by the intestinal mucosa and the liver&#46; Due to its low rate of absorption&#44; curcumin often combines with other compounds to increase absorption and boost the anti-inflammatory effect&#46; It has rapid hepatic elimination following intravenous infusion&#44; and it is a compound which is rapidly metabolised&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The anticoagulant effects of turmeric were analysed in an <span class="elsevierStyleItalic">in vitro&#47;in vivo</span> study&#46; It was demonstrated that turmeric inhibited the action of thrombin&#44; factor Xa and increased the aPTT and PT&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the case that we present&#44; the intake of high quantities of turmeric&#44; with no other influencing factor&#44; seems to be related to an increase in PT and aPTT&#44; which were reversed after stopping the intake&#44; with the altered parameters normalising&#46;</p></span>"
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Letter to the Editor
Curcumin intake in haemodialysis patients
Ingesta de curcumina en pacientes en hemodiálisis
Tania Monzón
Corresponding author
taniarmv@msn.com

Corresponding author.
, Francisco Valga, Fernando Henriquez
Servicio de Diálisis, Avericum S.L., Telde, Las Palmas, Spain
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with haematomas developing at the puncture sites&#44; and a lengthening of the haemostasis time of more than 2<span class="elsevierStyleHsp" style=""></span>h&#44; with bleeding at home and a need for referral to the emergency department on multiple occasions&#44; the dialysis parameters were adjusted to use a technique without heparin&#44; antiplatelet therapy was suspended and heparin sealing of the CVC was minimised&#46; However&#44; the increased haemostasis times persisted&#44; and there were also spontaneous bleeding episodes due to the lAVF at her home&#46; A fistolugram was performed with normal results&#46; In the laboratory tests&#44; an altered prothrombin time &#40;PT&#41; of 63<span class="elsevierStyleHsp" style=""></span>s and an activated partial thromboplastin time &#40;aPTT&#41;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>140<span class="elsevierStyleHsp" style=""></span>s were observed&#46; No underlying liver disease was revealed&#44; and the patient was not taking oral anticoagulants&#46; In light of this finding&#44; the patient was questioned again&#46; She reported taking turmeric infusions on a daily basis in quantities of 3&#8211;5<span class="elsevierStyleHsp" style=""></span>g&#46; We decided to suspend these infusions after reviewing the literature which mentions a possible anticoagulant effect&#44; as well as boosting the effects of antiplatelet therapy&#46; After 2 weeks of not using the lAVF and of abstaining from the turmeric infusions&#44; normal clotting times were displayed and the lAVF punctures were started again with no new haemorrhage incidences being presented until now&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Turmeric &#40;<span class="elsevierStyleItalic">Curcuma longa</span>&#41; is native to south-west India&#46; It is a herbaceous perennial plant from the Zingiberaceae family&#46; The most important chemical components of turmeric are a group of compounds called curcuminoids &#40;curcumin or diferuloylmethane&#44; demethoxycurcumin and bisdemethoxycurcumin&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> It also contains volatile oils such as turmerone&#44; atlantone and zingiberene&#44; as well as sugars&#44; proteins and resins&#46; Curcumin is responsible for its yellow colouring&#46; Turmeric is used routinely as a spice&#44; especially in Indian cuisine&#44; and as a food colouring&#46; Turmeric is now also used as a textile dye&#44; and it is used to dye wool&#44; cotton&#44; silk&#44; leather&#44; waxes&#44; stains&#44; etc<span class="elsevierStyleItalic">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> A wide range of biological and pharmacological activities of turmeric has been researched&#46; These include antioxidant&#44; anti-inflammatory&#44; antiviral&#44; antifungal&#44; hepatoprotective&#44; anti-cancer&#44; antimicrobial&#44; cardiovascular&#44; gastrointestinal&#44; nephroprotective&#44; anticoagulant and anti-diabetic effects&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Curcumin may bind to heavy metals such as cadmium and lead&#44; reducing their toxicity&#46; It also acts as an inhibitor of cyclooxygenase&#44; 5-lipoxygenase and glutathione <span class="elsevierStyleItalic">S</span>-transferase&#44; which converts it into an antioxidant&#44; like vitamins C&#44; E and beta-carotene&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The anti-inflammatory action of turmeric is probably due to a reduction in histamine production and also due to the fact that it increases and prolongs the action of cortisol&#46; Turmeric acts by stimulating bile production&#44; improving fat metabolism&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Pharmacokinetic studies in animals<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> have demonstrated that 40&#8211;85&#37; of oral curcumin passes through the gastrointestinal tract without changes&#44; the rest being absorbed by the intestinal mucosa and the liver&#46; Due to its low rate of absorption&#44; curcumin often combines with other compounds to increase absorption and boost the anti-inflammatory effect&#46; It has rapid hepatic elimination following intravenous infusion&#44; and it is a compound which is rapidly metabolised&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The anticoagulant effects of turmeric were analysed in an <span class="elsevierStyleItalic">in vitro&#47;in vivo</span> study&#46; It was demonstrated that turmeric inhibited the action of thrombin&#44; factor Xa and increased the aPTT and PT&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the case that we present&#44; the intake of high quantities of turmeric&#44; with no other influencing factor&#44; seems to be related to an increase in PT and aPTT&#44; which were reversed after stopping the intake&#44; with the altered parameters normalising&#46;</p></span>"
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ISSN: 20132514
Original language: English
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