ITP Conference 2008

Lombard, Illinois

Presentations

 Friday, June 20

“Introduction to ITP” – Dr. Amy Geddis

Immune thrombocytopenia is an acquired illness in which platelets are destroyed by antibodies, leading to symptoms of petechiae, bruising or bleeding.  The cause of ITP is not known, but in some cases may be due to ‘molecular mimicry,’ or a case of mistaken identity in which antibodies directed against a virus recognize similar antigens on platelets.  Antibody-coated platelets are destroyed by macrophages in the spleen.  In addition, antibodies may damage megakaryocytes, the platelet-producing cells of the bone marrow, leading to decreased production of new platelets.  Childhood and adult ITP are different, because in children most ITP is acute and resolves within 6 mo whereas in adults more patients go on to have chronic thrombocytopenia.  Treatment strategies for ITP include observation (if thrombocytopenia is mild and not associated with bleeding), therapies to block the production or function of anti-platelet antibodies, removal of the spleen, and stimulation of new platelet production. 

Saturday, June 21

 “Important Tips for Managing ITP:  What Every Patient Needs to Know”
- Dr. Howard Liebman and Dr. Michael Tarantino

THINGS YOU SHOULD KNOW ABOUT CHILDHOOD ITP - Michael Tarantino, MD
Immune thrombocytopenic purpura (ITP) is recognized as a common cause of thrombocytopenia, or low platelets in children.  Since its first recognition over 150 years ago, doctors and scientists have yet to identify the precise trigger.  Children tend to develop ITP in the weeks that follow a viral infection, implying that either the infection itself or the body’s immune response to the viral infection causes the thrombocytopenia.   Despite the recent replacement of “immune” for “idiopathic (or, of unknown cause)” in the name of the disorder, there are still aspects of ITP that remain idiopathic.

Most children that develop ITP will have a self-limited course, with complete resolution by six months after the onset.  About one fourth to one half with have spontaneous resolution in the second six months after the onset.  A small proportion of children will have a long-standing problem with low platelets, some of those needing periodic treatment to raise the platelet count and reduce bleeding symptoms.   Drug treatments don’t alter the ultimate outcome of ITP.   The only treatment shown to consistently alter the natural course of childhood ITP is splenectomy.  Splenectomy is not always the best treatment option for chronic ITP in children.  This is especially true in young children under the age of five years.

Drug treatments for ITP work by different mechanisms.  Some directly block the premature destruction of platelets  (IVIg and anti-D), some reduce the production of autoantibodies that bind to platelets and mark them for early destruction (steroids, rituximab and possibly IVIg and anti-D), some affect the T-lymphocyte response that signals the B-lymphocytes to make autoantibodies (cyclosporine, mycophenolate mofetil, etanercept), and some investigational agents stimulate the bone marrow to make enough platelets to overcome the premature destruction (romiplostim, eltrombopag).  Not all agents are appropriate for all children with ITP.

For the child with ITP, the degree of bleeding is often indirectly proportional to the severity of thrombocytopenia.  In other words, the lower the platelet count, the higher the likelihood of bleeding.  However, some children with very low platelet counts have minimal bleeding.  It is important to consider both the platelet number and the bleeding tendency when making decisions about treatment and restriction of physical activity.

 “New Treatments for ITP” - Dr. James Bussel and Dr. David Kuter

ITP has long been known to be a disorder of increased platelet destruction.  However, recent evidence has however brought to our attention the fact that ITP is also a disorder of reduced platelet production.  While almost all current therapies for ITP are directed towards decreasing the rate of platelet destruction, efforts to increase platelet production have only recently entered the clinical armamentarium of ITP therapies.  Two new drugs that mimic the action of the normal human hormone thrombopoietin have recently been extensively studied and one or both of these molecules will soon be available to treat ITP patients.  One molecule called romiplostim is a once weekly injection that was successful in raising the platelet counts in over 80% of ITP patients in a recent study; and the response was been maintained for up to 156 months.  Significant rates of response were seen in both splenectomized and nonsplenectomized patients.  It is anticipated that this molecule will be FDA approved and available for treatment in the next several months.  A second molecule, eltrombopag, is a daily oral medication that also increases the platelet count in over 80% of ITP patients and has also been found to be effective in their long-term care.  How these molecules might be used in the treatment of ITP patients will be discussed and their possible short-term and long-term side-effects analyzed. 

“Tired of Being Tired? Tips for Fighting Fatigue” - Robert F. DeMaria, DC, NHD

Dr. DeMaria will present natural solutions to solve the dilemma on how to satisfy the perpetual requirement to generate a continuous supply of renewable energy.  Your body functions at the cellular level; you will learn creating energy is an inside out process in which you can personally increase.  He will help you discover what foods have the nutrients to boost your vitality while avoiding those that bring exhaustion and burnout.  Dr. Bob will also provide tips on how you can increase oxygen for your entire system.  This will reduce your pain allowing for greater stamina, to perform daily activities and enjoy restful sleep.  The simple nuggets he will share can effortlessly be incorporated into your daily routine.

Sunday, June 22

“Inhabiting the Present Moment - An Introduction Into Mindfulness-Based Stress Reduction”
- Chris Smith

Have you ever had the experience of eating breakfast and then later in the day forgetting what you ate or how it tasted? Have you ever drove from the grocery story to home and completely forgot how you got there? These experiences are common and startling. Our minds and bodies in this life may feel like they are stuck on fast forward. One effect of this lifestyle is that we can miss a great deal of life—particularly the wonder and beauty that is all around us. We may sometimes feel as though we are on automatic-pilot. Just reacting. Ever talk with someone and note they are somewhere else? Or, have you ever been in a conversation and observed your mind thinking about dinner or where you might stop for the gas on the ride home? Mindfulness-Based Stress Reduction (MBSR) is one practice that provides an opportunity to slow down. It provides an invitation to inhabit the present moment. Why is the present moment important? It is because that is really all we have--the past is gone; the future is yet to be. In this experiential presentation, we will enter into a mindfulness practice as a first step toward inhabiting the present moment. From this practice, we will enter into a conversation about the practice of MBSR, about the MBSR program, about recent research and hopefully inspire you to inhabit the wonder, beauty and opportunity of the present moment.

“Basics of Healthy Eating” – Meredith McCarty

Healthy eating is one of the four aspects of a healthy lifestyle. This enjoyable practice contributes to both disease prevention and recovery. Do you knowWhich food groups contribute to maximum health?

• Which nutrients are most important: protein, minerals, vitamins, fats or carbohydrates?
• Which kinds of carbohydrates are best?
• Where does fiber come from and what is its purpose?
• What’s the difference between animal and plant proteins?
• What staples do you need to have on hand to create a sense of ease when time is of the essence and you’re hungry for really good food?

To make getting started easy, you’ll take home a shopping list of healing foods, a week’s worth of quick and easy menu plans for breakfast, lunch and dinner, and a resource list for more support.

“The Future of Healthcare” - Meredith McCarty, Chris Smith, Joan Young

Do you envision a medical future that includes personal genetic maps, preventative drugs and vaccinations, an average life expectancy of 100, electronic health records, personalized medicine, a focus on prevention or an entirely different paradigm?  The panel and audience share their views on the direction of healthcare and what each of us can do to help create the future we want.