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Cabbage (Brassica oleracea var capita) Extract for Platelet Elevation

A Research Paper

Presented to the Senior High School Faculty

Southwestern University - PHINMA

In Partial Fulfillment

of the Requirements for Research in STEM/Capstone

and Inquiries, Investigation and Immersion

Dela Cerna, Micah Fragile

Saladaga, Charis Drexlier
Lapitan, Kristine Hillary
Sedentario, Vincent
Candilanza, Janine
Saguban, Shawn
Canedo, Pamela
Ferolino, Floyd
Brocal, Vanissa
Chen, Oniel

December 2019
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CHAPTER 1

THE PROBLEM: RATIONALE AND BACKGROUND

Rationale

Philippines is one of the world’s emerging dengue thrombocytopenia

hotspots. According to Department of Health (DOH), there is an estimated 69,098
dengue cases were reported in the Philippines as of 2018. In fact, dengue
thrombocytopenia is the fastest spreading rector-born disease in the world endemic
in 100 countries. As a result, the researchers of this study aims to elevate the platelet
count of people suffering from low platelet count. Dengue thrombocytopenia is in
the top ten leading causes of deaths. Filipinos are not exemption to this incidence as
more and more Filipinos are affected by the disease. This study shows that the
organic compounds specifically the vitamin K found in cabbage (Brassica Olegacea
Var Capita) extract act as platelet elevation.

The thrombocytopenia or a disease in a blood platelet count is common

nowadays. According to U.S National Library of Medicine, thrombocytopenia can

put you at risk for serious internal bleeding. The platelets play an essential role in

helping your body from clots to stop bleeding. If one of your blood vessels gets

damaged, it sends out signals that are picked up by platelets.

Platelets are the cells that circulate within our blood and bind together when

they recognize damaged blood vessels. Platelets are merely circulating fragments of

cells. They contain proteins on their surface that allow them to stick to breaks in the

blood vessel wall and also to stick to each other. The main function of platelet is to
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help your body form clots to stop bleeding. If one of your blood vessels gets

damaged, it sends out signals that are picked up by platelets. (Dr.M.Williams).

Herbal remedies for plants are widely known in different regions in the

country where access to formal health care is limited. While many functional juices

that stabilize the platelet count are available, now resources and mechanism are

being sought to make it easy to control and elevate the platelets. In this study, the

researchers sought to find a herbal medicine to help in inhibiting the platelet count

elevation. (Rodriguez, C.J., 2019)

The cabbage is reported to have good medicinal values in traditional system

of medicine. Based on scientific studies, cabbage is an excellent source of vitamin K,

vitamin C and vitamin B6. The vitamin K plays a significant role in helping blood

clot and preventing excessive bleeding. The organic compounds present made the

researchers to hypothesize that this could be an effective mean in increasing the

platelet count elevation.

The researchers come up with this study to test the effectiveness of cabbage

extract in increasing platelet count, The researchers are aware that cases like

thrombocytopenia can decrease platelet count. The researchers wanted to help the

people and the community as well.

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Statement of the Problem

This study aims to determine the effect of Cabbage on blood platelet count.

Specifically, this aims to answer the following questions:

 How effective is the cabbage extract in increasing the blood platelet count of
pigs?
 Will the concentration of the extract affect the platelet elevation of pig’s
blood?

Hypotheses

Alternative:

If there is a significant difference on the blood platelet count before and after

application of the extract, then the Cabbage Extract is an effective alternative for

elevating the blood platelet count.

Null:

If there is no significant difference on the blood platelet count before and

after application of the extract, then the Cabbage Extract is not an effective
alternative for elevating the blood platelet count.
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Conceptual Framework

This section consists of the systematic experimentation of the study in testing

the hypotheses. It focused on the input works, the procedures and the output of the
whole process.

Input Process Output

i. Materials ii. Extraction of The cabbage extract
cabbage has the ability to
400 grams cabbage
increase the blood
Collection of blood
Blender platelet count.
samples
One filter cloth The greater the
Preparation of the set-
Plastic container cabbage extract
ups
concentration added to
Two syringe Laboratory Experiment the pig’s blood, the

946 mL of Mott’s greater the increase on

apple juice the blood platelet

count.
Distilled water

Figure 1.
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Significance of the Study

This study will benefit people with dengue thrombocytopenia that is more
likely to acquire low platelet count and damage to the large blood vessels and bone
marrow, causing internal bleeding which could be fatal if not treated. Moreover, the
Department of Health (2019) found that the median cost of diabetic medicine is
around 400 pesos, and an out-of-pocket hospitalization cost for one week
confinement is 20,000 pesos. The study also suggested not many patients utilize
PhilHealth assistance. Nearly three fourths of dengue thrombocytopenia patients
omitted an item off their health care because of financial restriction. Utilizing the
Cabbage extract, which requires less cost will financially help the people diagnosed
with dengue thrombocytopenia. Pharmaceuaticuls and the community can also
benefit from the study in a way of knowing the alternative and cost-efficient way in
treating low platelet count.

Scope and Limitations of the Study

This study primarily focused on how helpful the cabbage (Brassica oleracea
var capita) extract for platelet elevation. This study will also tackle on how effective
the cabbage (Brassica oleracea var capita) extract in increasing the blood platelet
count. The researchers will be using slaughtered pigs as test subjects. In performing
the experiment the researchers must wear gloves to avoid wounds or cuts from the
chemical used and lab gowns are required to avoid chemicals from having contacts
with skin.This investigation and all it’s preparation lasts for almost two weeks.
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Definition of Terms

The following are defined conceptually and operationallyfor the readers to

understand the terms and these are as follows:

Blood clot. a gelatinous mass of fibrin and blood cells formed by the
coagulation of blood.; try to repair damage to a blood vessel, either an artery or vein.
When blood clots form inappropriately inside an artery or vein, they
may cause significant problems because blood flow past the clot is decreased.

Cabbage . a cultivated plant eaten as a vegetable, havingthick green or purple

leaves surrounding a spherical heart or head of young leaves.; a green leaf vegetable
that has a good source of Vitamin K, and get a higher chance inelevating platelets.

Extraction. the action of taking out something, especially using effort or

force.; a tool that helps the blood platelet to rise and to prevent from causing diseases
from a low platelet count.

Platelet Elevation. the action or fact of elevating or being elevated.; a

condition which rises the blood platelet to help the clots from the body to stop
bleeding and to heal those damaged vessels.

Sulforaphane.  an anticarcinogenic isothiocyanate C6H11NOS2 found in

cruciferous vegetables (as broccoli and cauliflower) that is thought to function by
stimulating the production of enzymes in the body that detoxify cancer-causing
substances.; is a chemical found in certain kinds of vegetables such as broccoli,
cabbage, and cauliflower.

Thrombocytopenia. deficiency of platelets in the blood. This causes bleeding

into the tissues, bruising, and slow blood clotting after injury.; a condition that
damage or decrease your platelet production which leads to common diseases like
Leukemia, anemia, and Hepatatis C.
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RELATED LITERATURE REVIEW

Related Legal Bases

Dengue as of the dangerous disease in the world causing hundreds of lives

taken. President Fidel V. Ramos hereby establishes the “nation Tepok Lamok,
dengue Sapok” program. The program was launched on 02 aug 1998. Since the
government seeks to reduce dengue infection. Vaccines have been made. We have
found out that cabbage extract has the ability to prevent or help reducing the factors
of dengue for it helps elevate the blood platelet. This study will help find the
commnity and alternative way of reducing the factors of having dengue.

Another law proposed which is Republic Act No. 7719, also known as the
National Blood Services Act of 1994, promotes voluntary blood donation to provide
sufficient supply of safe blood and to regulate blood banks. This act aims to inculcate
public awareness that blood donation is a humanitarian act.

The “National Blood Service Act of 1994” with its’ AO 9 s 1995 on rules and
regulations for implementation was formulated to ensure safe and efficient blood
banking and transfusion practices in the Philippines. Regulation of blood services
was under the Bureau of Research and Laboratories. In 2005, the Philippine National
Blood Service was created amending some of implementing rules in AO 9 s 1995.
Thus a new AO 8 s 2008 was formulated to provide rules and regulation governing
blood service facilities.

Related Literature

• Blood Clots

Blood clotting is an important process that prevents excessive bleeding when a

blood vessel is injured. Platelets and proteins in the plasma work together to stop the
bleeding by forming a clot over the injury. The body will naturally dissolve the blood
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clot after the injury has healed. Sometimes, clots form on the inside of vessels
without an obvious injury or do not dissolve naturally. These situations can be
dangerous and require accurate diagnosis and appropriate treatment.

Clots can occur in veins or arteries. While both types of vessels help transport
blood throughout the body and they function differently. Veins are low-pressure
vessels that carry deoxygenated blood away from the body's organs and back to the
heart. An abnormal clot that forms in a vein may restrict the return of blood to the
heart and can result in pain and swelling as the blood gathers behind the clot. Deep
vein thrombosis (DVT) is a type of clot that forms in a major vein of the leg or, less
commonly, in the arms, pelvis, or other large veins in the body. In some cases, a clot
in a vein may detach from its point of origin and travel through the heart to the lungs
where it becomes wedged, preventing adequate blood flow. This is called a
pulmonary (lung) embolism (PE) and can be extremely dangerous. (American
Society of Hematology 2018)

• What Are Platelets?

Platelets are made in the bone marrow similar to other cells in the blood. Platelets
originate from megakaryocytes, which are large cells found in the bone marrow. The
fragments of these megakaryocytes are platelets that are released into the blood
stream. The circulating platelets make up about two third of the platelets that are
released from the bone marrow. Platelets are tiny blood cells that help the body form
clots to stop bleeding. If one of the blood vessels gets damaged, it sends out signals
that are picked up by platelets. The platelets then rush to the site of damage and form
a plug, or clot, to repair the damage. The process of spreading across the surface of a
damaged blood vessel to stop bleeding is called adhesion. This is because when
platelets get to the site of the injury, they grow sticky tentacles that help them bond.
They also send out chemical signals to attract more platelets to pile onto the clot in a
process called aggregation. Platelets are made in the bone marrow along with your
white and red blood cells. The bone marrow is the spongy center inside your bones.
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Another name for platelets is thrombocytes. Healthcare providers usually call a clot a

thrombus. Once platelets are made and circulated into your bloodstream, they live
for 8 to 10 days. (Adam S. Levy 2018)

• The Health Benefits of Cabbage

Cabbage is often grouped into the same category as lettuce because of their
similar appearance, it is actually a part of the cruciferous vegetable family. Cabbage
can vary in color from red to green and purple, and the leaves can be smooth or
wrinkled. Half a cup of cooked cabbage contains 81.5 micrograms of vitamin K, 11
milligrams of magnesium and 22 micrograms of folate. Plus, lesser amounts of
vitamin B-6, calcium, potassium, and thiamin. Cabbage contains the antioxidants
choline, beta-carotene, lutein, and zeaxanthin as well as the flavonoids kaempferol,
quercetin, and apigenin. The cabbage may help protect against radiation,
prevent cancer, and reduce heart disease risk. (Megan Ware RDN LD2017)

Cabbage contains compounds called glucosinolates, which are associated with

lowering cancer risk based on how much you eat. The process of digesting and
metabolizing cabbage essentially unleashes a chemoprotective effect in the body,
helping stop the enzymatic reactions linked to DNA damage — the type that can,
over time, lead to tumor development.

• Low Platelet Count (Thrombocytopenia)

Thrombocytopenia abnormally low number of platelets (thrombocytes) in the

circulation. Normal platelet counts are between 150,000 and 400,000 per cubic
millimetre. When the platelet count drops to 50,000 to 75,000 per cubic millimetre,
and particularly to 10,000 to 20,000 per cubic millimetre, spontaneous bleeding may
occur.When a person’s skin is or broken or injured, platelets clump together and
form clots to stop the bleeding. When a person does not have enough platelets in the
blood, the body cannot form clots. A low platelet count may also be called
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thrombocytopenia. This condition can range from mild to severe, depending on its
underlying cause. For some, the symptoms can include severe bleeding and are
possibly fatal if they are not treated. Other people may not experience any
symptoms. Typically, a low platelet count is the result of a medical condition,
like leukemia, or certain drugs. The treatment usually addresses the condition
causing the thrombocytopenia. Whether or not a person experiences symptoms of a
low platelet count depends on his/her platelet count. Mild cases, such as when a low
platelet count is caused by pregnancy, usually do not cause any symptoms. More
severe cases may cause uncontrollable bleeding, which requires immediate medical
attention. Each platelet lives about 10 days in a healthy body. A low platelet count
can also be a result of the body destroying too may platelets. This can be due to side
effects of certain medications, include diuretics and anti-seizure medications.(Janelle
Martel 2016)

Cabbage ranked in our WHFoods rating system as an excellent source of vitamin

C and a very good source of manganese. But in terms of antioxidants in the newer,
phytonutrient category, cabbage is impressive, even among cruciferous
vegetables. (Jasper, 2014)

The cabbage may help protect against radiation, prevent cancer, and reduce heart
disease riska recent report in the American Journal of Clinical Nutrition associated
the intake of flavonoid-rich foods with a lower risk of death from cardiovascular
disease and stated that even small amounts of flavonoid-rich foods might be
beneficial. The high polyphenol content in cabbage might also reduce the risk of
cardiovascular disease by preventing platelet buildup and reducing blood pressure.A
popular way to consume cabbage is in a fermented form such as sauerkraut and
kimchi. Chocked full of probiotics, fermented foods might be one of the best things
you can consume for your immune and digestive systems. Healthy microbes generate
an acidic environment to preserve and develop flavor; the enzymes produced in
fermentation make vitamins and minerals easier to absorb.(Gill, 2009)
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• The New Benefits of Cabbage

Cabbage and all other cruciferous vegetables all belong to the family of plan ts
called the Brassicaceae. Despite of the literal translation of "brasssica" as "cabbage,"
this family of plants is seldom referred to as the "cabbage family." It is referred to as
the "mustard plant family." When people talk about the "brassica" family of plants,
they are talking about the plant family that includes both cabbage and mustard.
Historically, this family of plants was most commonly referred to as the Crucifereae.

Cabbage is an excellent source of vitamin K, vitamin C and vitamin B6. It is also a

very good source of manganese, dietary fiber, potassium, vitamin B1, folate and
copper. Additionally, cabbage is a good source of choline, phosphorus, vitamin B2,
magnesium, calcium, selenium, iron, pantothenic acid, protein and niacin. Cabbage
is also a unique source of several types of phytonutrients. Its overall antioxidant
activity is largely due to its unusual phenol and polyphenol content. With red
cabbage, these polyphenols include antioxidant and anti-inflammatory compounds
called anthocyanins. Cabbage is also unique for it rich supply of glucosinolates.
These phytonutrients can be converted by the body into isothiocyanates that have
special detoxification and anti-cancer properties. (George Mateljan2009)

• Vitamin K

Vitamin K plays a significant role in helping the blood clot and preventing

excessive bleeding. Unlike many other vitamins, vitamin K is not typically used as
a dietary supplement.

Vitamin K is actually a group of compounds. The most important of these

compounds appears to be vitamin K1 and vitamin K2. Vitamin K1 is obtained from
leafy greens and some other vegetables. Vitamin K2 is a group of compounds largely
acquired from meats, cheeses, and eggs, and synthesized by bacteria. Some people
have looked to vitamin K2 to treat osteoporosis and steroid-induced bone loss. Low
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levels of vitamin K can raise the risk of uncontrolled bleeding. While vitamin
Kdeficiencies are rare in adults, they are very common in newborn infants. A single
injection of vitamin K for newborns is standard. Vitamin K is also used to counteract
an overdose of the blood thinner. (WebMD LLC 2005)

Related Studies

Foreign Studies

Optimal treatment of acute ST-elevation myocardial infarction (STEMI)

requires early re-canalisation of the occluded coronary artery by primary
percutaneous coronary intervention (PPCI) and passivation of coronary artery
thrombosis with combined antiplatelet and anticoagulant drugs.

Prasugrel provides fast and effective platelet inhibition, although high

baseline platelet activity, reduced drug bioavailability and concomitant use of opiates
in the setting of STEMI may delay the antiplatelet effect of a loading dose.
Bivalirudin causes rapid thrombin inhibition and has a low bleeding risk. However,
its short half-life is associated with an increased risk of acute stent thrombosis (ST)
when treatment is limited to the peri-procedural period.

It was hoped that combined use of bivalirudin with prasugrel, a more potent
oral P2Y12 antagonist than clopidogrel, would provide faster and more consistent
inhibition of platelet activity, with improved clinical outcomes, particularly through
minimizing the risk of acute ST. Unfortunately BRAVE-4, a trial designed to test
this combination of agents, was stopped prematurely due to slow recruitment and
analysis of the outcomes for the 548 patients enrolled failed to show superiority of
bivalirudin/prasugrel vs heparin/clopidogre.

Acute STEMI pharmacotherapy is challenged by the potential conflict

between shortening the time to revascularization and consequent reduction of
exposure of patients to anti-platelet and anti-thrombotic therapy. PINPOINT-PPCI
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was designed to address these uncertainties. We aimed to profile platelet activity

during the first 24 hours of treatment for STEMI using bivalirudin and prasugrel.
Recent clinical data has highlighted an increased risk of acute ST in revascularized
target lesions when bivalirudin is used, compared to unfractionated heparin
monotherapy combined with potent oral P2Y12 inhibition. Our study tests the
interaction between procedural timing and acute antiplatelet and antithrombotic
therapy, providing insights into the mechanisms driving acute ST with use of
prasugrel and procedural bivalirudin. (Johnson, T., et al, n.d.)

Local Studies

Research over the past 30 years has consistently shown that consuming
cruciferous vegetables is associated with a lower risk of cancer. Researchers
are currently testing sulforaphane's ability to delay or impede cancer. Promising
results at the molecular level have been seen with multiple types of cancers,
including melanoma, esophageal, prostate, and pancreatic. Researchers have
discovered that sulforaphane has the power to inhibit the harmful enzyme histone
deacetylase (HDAC), known to be involved in the progression of cancer cells. The
ability to stop HDAC enzymes could make sulforaphane-containing foods a
potentially powerful part of cancer treatment.(Megan, 2017)

Thrombocytopenia has a variable incidence in the May-Hegglin anomaly, a

rare congenital syndrome characterized by inclusions resembling Dohle bodies
within leukocytes, thrombocytopenia, and giant platelets. We studied a 16-year-old
girl and three relatives with the syndrome to elucidate the pathogenesis of the
thrombocytopenia and the degree of impaired hemostasis. On confirmation of
automated platelet counts by manual techniques we found that both aperture-
impedence and light-scatter instruments tended to undercount the actual number of
platelets by 30-50%. An enzyme immunoassay for platelet-associated IgG showed
elevated levels in all patients (mean of 2.3 +/- 0.6 ng/10(6) platelets versus 0.8 +/-
0.6 in normals, p less than 0.0001). Bleeding time and platelet aggregation in
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response to adenosine diphosphate, arachidonic acid, epinephrine, ristocetin, and

collagen were all normal. No clinical bleeding was observed in any of the patients in
the face of major surgery or childbirth. The findings suggest the possibility of a
peripheral destructive and perhaps an immune pathogenesis of the thrombocytopenia
of May-Hegglin anomaly and confirm that clinical bleeding may not accompany the
severe thrombocytopenia seen in this disorder.

Furthermore given the roles of oxidative stress and chronic inflammation as

risk factors for cancer, the antioxidant and anti-inflammatory richness of cabbage
would provide anti-cancer health benefits without the addition of cabbage's
glucosinolates. But glucosinolates are cabbage's trump card with regard to "anti-
cancer" benefits. The glucosinolates found in cabbage can be converted into
isothiocyanate compounds that are cancer preventive for a variety of different
cancers, including bladder cancer, breast cancer, colon cancer, and prostate cancer.
(George, 2001)
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METHODOLOGY

Research Method

There will be five (5) trials and each trial contains two replicates. The 5 trials

are; (1) positive control which is the Mott’s Apple Juice, (2) the negative control

which is the distilled water, (3) the 100% concentration which is the 2 mL cabbage

extract, (4) the 75% concentration which is 1.5 mL cabbage extract and .5 distilled

water, (5) the 50% concentration which is 1 mL cabbage extract and 1 mL distilled

water. Platelet count will be gathered before and after the administration of the

cabbage extract.

Research Materials

Four hundred (400) grams cabbage, blender, one (1) filter cloth, one (1)

plastic container for the extract, two (2) syringe for the collection of blood samples,

one (1) 946 mL of Mott’s Apple Juice, 1 (one) distilled bottled water, fifteen (15)

test tubes are the materials needed in conducting the experiment.

Equipment/ Apparatus and Utensils

Test tubes, two (2) for positive control and negative, tongs, one (1) helps hold

the test tube, funnel, one (1) to properly transfer the cabbage extract, mortar and

pestles, one (1) helps squeeze the cabbage.

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Procedure

• Sample Collection and Preparation

The Cabbage will be collected from the market of Lipata,

Minglanilla, Cebu. The cabbage is then washed with tap water. Buying

of syringe, distilled water, fine cloth and Mott’s apple juice.

• Extraction of Cabbage

Four hundred (400) grams of cabbage will be washed with

running tap water and will be weighed using triple beam balance. It will

be then air dried, cut and blend using a blender and extract it by

squeezing the blended cabbage by using the mortar and pestle.

• Collection of blood samples

There will be two (2) ml of pig’s blood in each of the 10 test

tubes. The blood samples are going to be collected from a slaughtered pig

at Abattoir, Talisay City, Cebu.

• Preparation of Extract Concentration

There are five (5) set-ups; Set up A is the 2ml Mott’s Apple Juice

(positive control). Set up B is 100% concentration that has 2ml of

Cabbage extract without adding distilled water. Set up C is 75%

concentration that has 1.5 ml of Cabbage extract and 0.5 ml of water. Set
 18

up D is 50% concentration that has 1ml of Cabbage extract and 1 ml of

water. Set up E is the water (negative control).

• Risk and Safety

The scope of the project or experiment and potential hazards

involved must be determined, the substance and processes must be

identified. In performing the experiment, the researchers must wear

gloves to avoid wounds or cuts from the chemical used and lab gowns are

required to avoid chemicals from having contact with skin.

• Data Analysis

• One – way ANOVA is used to analyze the platelet

elevation of the different groups.

• Graphs and tables were used in showing the different

results of the test.

Evaluation of the Product

The cabbage extract is effective in increasing the blood platelet count for the
trials. It was found out that there is the greater the cabbage extract concentration
added to the pig’s blood, the greater the increase on the blood platelet count.
 19

Statistical Treatment

Each result is expressed as the mean of Platelet Elvation. Statistical

differences in platelet elevation in control and sample groups at each administrations

time are going to be evaluated using single-factor analysis of variance (one-way

ANOVA)
 20

Schedule of Activities

Date Time Location Activities

 Minglanilla  Buying of

Market cabbages
December
 Talisay City  Buying of
28, 2019 4:30PM – 7:00 PM
(Rose syringes,distill

Pharmacy & ed water, filter

Fooda) cloth and

 Naga Mott’s apple

juice

 Extracting of

cabbage

 Abbatoir  Colleecting of

December 29, 4:30AM– 7:00 AM Talisay blood samples

2019  Minglanilla from

slaughtered

pigs

 Doing the

experiment
 21

REFERENCES

1. Articles

King, D. J., & Kelton, J. G. (1984). Heparin-associated

thrombocytopenia. Annals of internal medicine, 100(4), 535-540.

Roffi, M., Chew, D. P., Mukherjee, D., Bhatt, D. L., White, J. A., Heeschen,
C., ...&Kleiman, N. S. (2001). Platelet glycoprotein IIb/IIIa inhibitors
reduce mortality in diabetic patients with non–ST-segment-elevation
acute coronary syndromes. Circulation, 104(23), 2767-2771.
2. Journals

Musselman, D. L., Tomer, A., Manatunga, A. K., Knight, B. T., Porter, M.

R., Kasey, S., ...&Nemeroff, C. B. (1996). Exaggerated platelet

reactivity in major depression. The American journal of psychiatry.

3. Websites

Blood Clots. (2005). Retrieved December 10, 2019, from

https://www.hematology.org/Patients/Clots/

Cabbage. (2009). Retrieved December 10, 2019, from

http://www.whfoods.com/genpage.php?tname=foodspice&dbid=19

Griffin, M. (2008, April 15). Vitamin K. Retrieved December 10, 2019, from
https://www.webmd.com/vitamins-and-supplements/supplement-guide-
vitamin-k#1
Johnson, T. W., Mumford, A. D., Scott, L. J., Mundell, S., Butler, M., Strange, J. W.,
… Baumbach, A. (n.d.). A Study of Platelet Inhibition, Using a 'Point of Care'
Platelet Function Test, following Primary Percutaneous Coronary Intervention for
ST-Elevation Myocardial Infarction [PINPOINT-PPCI]. Retrieved from
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0144984.
 22

Levy, A. S. (2018). What Are Platelets? - Health Encyclopedia - University of

Rochester Medical Center. Retrieved December 10, 2019, from
https://www.urmc.rochester.edu/encyclopedia/content.aspx?
ContentTypeID=160&ContentID=36

Martel, J. (2018, October 5). Low Platelet Count (Thrombocytopenia). Retrieved

December 10, 2019, from
https://www.healthline.com/health/thrombocytopenia

Ware, M. R. (2017, November 2). The health benefits of cabbage. Retrieved

December 10, 2019, from
https://www.medicalnewstoday.com/articles/284823.php
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Appendix A

Letter Of Permission To The Principal

Southewestern University PHINMA
Urgello St., Cebu City
Senior High School Department

December 2019

MR. PATRICK SALINAS

Principal, Southwestern University PHINMA
Urgello St., Cebu City

Dear Sir;

Greetings of Peace!

We, the researchers, students of Southwestern University PHINMA is

currently working on a research entitled ‘Cabbage Extract for Platelet Elevation.
If you find this study beneficial and relevant for you to agree, kindly sign this letter
acknowledging your consent and permission for us to further pioneer this study at
Southwestern University-PHINMA.
Your approval to conduct this study will be greatly appreciated. Thank you in
advance for your interest and assistance with this research.
 24

Respectfully yours,

Brocal, Vanissa
Ferolino, John Floyd
Candilanza, Janine
Lapitan, Kristine Hillary
Chen, Oniel
Saguban, Shawn Lester
Canedo, Pamela
Saladaga, Charis Drexlie
Dela cerna, Micah Fragile
Sedentario ,Vincent