HIJAMAH THERAPY AND THE LIFE CYCLE OF A RED BLOOD CELL

Many Hijamah practitioners fall into the trap of calling back patients for remedial therapy without the patient having adequate healing time  from a previous session.

The minimum time span should be 4-6 weeks before another session should be administered . Most therapists do not have the knowledge or reasoning as to why i advise this to patients.

We must understand the concepts of the formation of Red Blood Cells...Otherwise it is futile for patients to undertake the treatment of wet cupping therapy (Hijamah).

Let us take a look at the physiology of a Red Blood Cell (RBC)

During its approximately four-month lifespan, the human red blood cell (RBC) travels approximately 300 miles, making approximately 170,000 circuits through the heart, enduring cycles of osmotic swelling and shrinkage while travelling through the kidneys and lungs, and an equal number of deformations while passing through capillary beds . It has been speculated that accumulated damage to the RBC, especially to its membrane, renders the aging RBC unfit to circulate, leading to its destruction, via mechanisms that are poorly understood.

The normal time of RBC senescent (age-related) death in adults is approximately 110 to 120 days. Hemolysis can therefore be arbitrarily defined as a shortening in the survival of circulating RBCs to a value of less than 100 days.

This short life span necessitates the process erythropoiesis, which is the formation of red blood cells. All blood cells are formed in the bone marrow. This is the erythrocyte factory, which is soft, highly cellar tissue that fills the internal cavities of bones.

During intrauterine development, the early stages of life, erythrocytes are produced first by the yolk sac and then by the developing spleen during the third month of gestation, until the bone marrow is formed in the seventh month and takes over erythrocyte production exclusively.

ERYTHROCYTE DIFFERENTIATION

Erythrocyte differentiation takes place in 8 stages. It is the pathway through which an erythrocyte matures from a haemocytoblast into a full-blown erythrocyte. The first seven all take place within the bone marrow. After stage 7 the cell is then released into the bloodstream as a reticulocyte, where it then matures 1-2 days later into an erythrocyte. The stages are as follows:

1. Hemocytoblast, which is a pluripotent hematopoietic stem cell

2. Common myeloid progenitor, a multipotent stem cell

3. Unipotent stem cell

4. Pronormoblast

5. Basophilic normoblast also called an erythroblast.

6. Polychromatophilic normoblast

7. Orthochromatic normoblast

8. Reticulocyte

Erythrocytes are derived in the red bone marrow from pluripotent stem cells that give rise to all types of blood cells. Myeloid stem cells are partially differentiated cells that give rise to erythrocytes and several other types of blood cells.

Nucleated erythroblasts are committed to becoming mature erythrocytes. These cells extrude their nucleus and organelles, making more room for heamoglobin. Reticulocytes are immature red blood cells that contain organelle remnants. Mature erythrocytes are released into the capillaries. The pictures in this link and here show the steps of differentiation.

DISTINCT CHARACTERISTICS OF ERYTHROCYTES DURING ERYTHROPOIESIS

These characteristics can be seen during erythrocyte maturation:

• The size of the cell decreases

• The cytoplasm volume increases

• Initially, there is a nucleus and as the cell matures the size of the nucleus decreases until it vanishes with the condensation of the chromatin material.

Functions of Red Blood Cells

Apart from carrying oxygen, which is the main function of red blood cell, it can also conduct the following functions.

1. Release the enzyme carbonic anhydrase which allows water in the blood to carry carbon dioxide to the lungs where it is expelled.

2. Control the pH of the blood by acting as an acid-base buffer.

Shape and Size of a Red Blood Cell

A red blood cell is a biconcave disc. Simply it is a round ball that is squeezed from two opposite ends to appear, widest at the sides and narrowest in the middle.

A red blood cell measures about 6 to 8 micrometers in diameter (average = 7.8 um) with an average thickness of 2 micrometers (2.5 um at the thickest point and less than 1um at the center). Although a red blood cell is wider than some capillaries, its flexibility allows it to become distorted as it squeezes through narrow passages and then restores  to its original shape.

Quantity of Red Blood Cells in the Human Body

The average male adult has about 5 million red blood cells per cubic millimeter of blood, while the average female adult has about 4.5 millionred blood cells per cubic milliliter of blood. This may vary by about 300,000 to 500,000 red blood cells. The number of red blood cells may vary depending on geographical location – a person who lives in high altitudes will have more red blood cells.

Structure of Red Blood Cells

Red blood cells have an unusual structure compared to other cells in the human body. It lacks a nucleus, mitochondria or endoplasmic reticulum. However enzymes within the red blood cells allow it to produce small amounts of energy (ATP from glucose). The most important part of a red blood cell is haemoglobin, which is essentially the functional component of the cell.

Haemoglobin Structure

Haemoglobin is the molecule that is responsible for the oxygen carrying capacity of a red blood cell. It also gives these cells a red colour and is a combination of haeme and globin. Haeme is formed when succinyl-CoA binds with glycine to form a pyrrole molecule. Four of these pyrrole molecules combine to form protoporphyrin IX which binds with iron to form the haeme molecule. Globin is a long polypeptide chain.

When a haeme molecule and globin molecule combine, it forms a haemoglobin chain. There may be slight variations in the haemoglobin chains designated as alpha, beta, gamma and delta chains. Four of these chains need to combine to form the final haemoglobin molecule and the most common combination in the human body, termed haemoglobin A, is made up of two alpha and two beta chains.

Each iron molecule can bind with one oxygen molecule, which contains two oxygen atoms. Since each haemoglobin chain has one iron atom and each haemoglobin molecule has 4 chains and therefore 4 iron molecule,s each haemoglobin molecule can carry 8 oxygen atoms.

Every 100 milliters of blood, which contains various blood components, has about about 15 grams of haemoglobin.

REGULATION OF ERYTHROPOIESIS

Thinking logically you might suspect that because the primary function of erythrocytes is to transport O2 (Oxygen) in the blood, the primary stimulus for erythrocyte production is low O2 levels. You would be correct, but low O2 levels do not stimulate erythropoiesis by acting directly on the bone marrow.

Instead, it stimulates the kidneys to secrete the hormone erythropoietin into the blood, and this hormone in a domino effect stimulates the bone marrow to produce erythrocytes.

Erythropoietin acts on derivatives of undifferentiated cells that have already been committed to becoming red blood cells (RBC’s), stimulating the proliferation and maturation of these cells into mature RBCs.

This increase in erythropoietic activity elevates the number of circulating RBCs, thereby raising the O2 carrying capacity of the blood and restoring the delivery of O2 to the body tissues to normal. Once the O2 level in the tissues of the kidneys is brought back to normal, erythropoietin secretion is turned down until it is needed again. This is an example of a negative feedback mechanism.

CONCLUSION

Having mentioned all this. A normal red blood cell lives for about 120 days. It takes about two days for the body to manufacture each red blood cell, and about two million are turned out every second. Production of new red blood cells occurs in the bone marrow.The main job of red blood cells is to carry oxygen from the lungs to cells throughout the body. Red blood cells aid in the removal of carbon dioxide, which is a waste product of several of the body's chemical processes. The body must produce additional red blood cells because they eventually break down and cannot perform their functions. Cells in the spleen, liver and bone marrow eliminate useless red blood cells.

It takes RBC`s 7 days to mature..However they DO NOT reach their full size until about 4 weeks(30days)....If Hijamah is adminstered before these cells reach their full maturation stage...Then there is every possibility that these too would pass through the semi permeable walls of the capillary bed along with the morbid matter thus rendering the patient weak rather than having any positive therapeutic benefit.

It is absolutely imperative that the patient should be allowed sufficient recovery time before they are brought back for their next remedial session.

The benefit of such precautionary measures will yield in much greater results inshaAllah