Iron overload is a big challenge when treating thalassemia (TM), hemochromatosis and sideroblastic anemia.
It persists even after cure of TM with bone marrow transplantation. Iron overload results from
increased iron absorption and repeated blood transfusions causing increased iron in plasma and interstitial
fluids. Iron deposition in tissues e.g. heart, liver, endocrine glands and others leads to tissue damage
and organ dysfunction. Iron chelation therapy and phlebotomy for iron overload have treatment difficulties,
side effects and contraindications. As mean iron level in skin of TM patients increases by more than
200%, percutaneous iron excretion may be beneficial. Wet cupping therapy (WCT) is a simple, safe and
economic treatment. WCT is a familiar treatment modality in some European countries and in Chinese
hospitals in treating different diseases. WCT was reported to clear both blood plasma and interstitial
spaces from causative pathological substances (CPS). Standard WCT method is Al-hijamah (cupping,
puncturing and cupping, CPC) method of WCT that was reported to clear blood and interstitial fluids better
than the traditional WCT (puncturing and cupping method, PC method of WCT). In other word, traditional
WCT may be described as scarification and suction method (double S technique), while Al-hijamah
may be described as suction, scarification and suction method (triple S technique). Al-hijamah is a more
comprehensive treatment modality that includes all steps and therapeutic benefits of traditional dry cupping
therapy and WCT altogether according to the evidence-based Taibah mechanism (Taibah theory).
During the first cupping step of Al-hijamah, a fluid mixture is collected inside skin uplifting due to the
effect of negative pressure inside sucking cups. This fluid mixture contains collected interstitial fluids
with CPS (iron, ferritin and hemolyzed RBCs in thalassemia), filtered fluids (from blood capillaries) with
iron and hemolyzed blood cells (hemolyzed RBCs, WBCs and platelets). That fluid mixture does not contain
intact blood cells (having diameters in microns) that are too big to pass through pores of skin capillaries
(6–12 nm in diameter) and cannot be filtered. Puncturing skin upliftings and applying second
cupping step excrete collected fluids. Skin scarifications (shartat mihjam in Arabic) should be small,
superficial (0.1 mm in depth), short (1–2 mm in length), multiple, evenly distributed and confined to skin
upliftings. Sucking pressure inside cups (150 to 420 mmHg) applied to skin is transmitted to around
skin capillaries to be added to capillary hydrostatic pressure (33 mmHg at arterial end of capillaries and
13 mmHg at venous end of capillaries) against capillary osmotic pressure (+20 mmHg). This creates a
pressure gradient and a traction force across skin and capillaries and increases filtration at arterial end
of capillaries at net pressure of 163 to 433 mmHg and at venous end of capillaries at net pressure
of 143 to 413 mmHg resulting in clearance of blood from CPS (iron, ferritin and hemolyzed blood
cells). Net filtration pressure at renal glomeruli is 10 mmHg i.e. Al-hijamah exerts a more pressurehttp://