Platelet E-News: December 27, 2012

This e-newsletter is a monthly publication of the Platelet Disorder Support Association. The information in this newsletter is for educational purposes only. For advice on your unique medical condition, please consult a health care professional.



Current Treatments



New Treatments



Understanding ITP



The ASH abstract numbers and titles are listed below the summaries. You can search on the number and read the abstracts at (after you agree with the terms). See for additional meeting information.

More ASH information will be summarized in the next two issues of The Platelet News. For information on receiving that 28-page newsletter see


Current Treatments



Participants in prior studies of eltrombopag were given the opportunity to continue taking the pills to help determine the long-term efficacy and side effects of the treatment. Of the people in the extended study, some treated for more than 5 years, 85% achieved a platelet count of 50,000/uL or greater at least once, and 62% had a platelet count of 50,000/uL or greater for at least half the time. The most common side effect was a headache.

2198 "Long-Term Safety and Efficacy of Eltrombopag in Adults with Chronic Immune Thrombocytopenia (ITP): Report of up to 5.5 Years of Treatment in EXTEND"



Researchers summarized the detail data from 13 romiplostim studies published between 2002 and 2011 and compared the adverse events of those taking romiplostim with a control group receiving a placebo or usual treatments for ITP. Of the 1059 patients evaluated, more than 90% in both groups reported adverse events. The most common adverse event was headache. The romiplostim group had more bone pain and nausea. The placebo/usual care group reported more bleeding and treatment-related adverse events.

2185 "Integrated Analysis of Long Term Safety in Patients (pts) with Chronic Immune Thrombocytopenia (ITP) Treated with Romiplostim"


Dr. Jim Bussel and Caroline Kruse


Researchers reported results of an extension to the romiplostim (Nplate) clinical trial in children with severe, chronic ITP. The participants, treated for more than 2 years, responded well, with usual platelet counts equal to or above 50,000/uL. The treatment was generally well-tolerated, although some of the participants needed rescue therapy for bleeding events. The study is ongoing.

621 "Long-Term Use of Open-Label Romiplostim in Children with Chronic/Refractory Immune Thrombocytopenia (ITP)"



Children with chronic ITP often have a reduced quality-of-life due to activity restrictions, fears, and the consequences of treatment. In addition to measuring the platelet count for children enrolled in a clinical trial of eltrombopag, researchers asked the older children and parents of the younger children to complete a quality-of-life questionnaire before treatment and as treatment progressed. The preliminary results show that treatment with eltrombopag improved the quality-of-life for almost all the clinical trial participants.

2197 "Health-Related Quality of Life in Children with Chronic Immune Thrombocytopenia Treated with Eltrombopag in the PETIT Study"

Note: For more information on eltrombopag and romiplostim see:


New Treatments



Results for an initial safety and dosing study for a new treatment for ITP, SM101, had very positive results. About 75% of the participants receiving the highest dose responded to a single course of treatment at 20 days and the response lasted at least 3 months after stopping the treatment. SM101 works differently from other treatments for ITP. It blocks the action of immune complexes, thereby reducing the autoimmune response and associated inflammation. SuppreMol, the German manufacturer of SM101, plans additional clinical studies in the US and Europe in 2013.

3388 "Interim Results From a Phase Ib/IIa Clinical Trial with the Soluble Fc-Gamma IIb Receptor SM101 for the Treatment of Primary Immune Thrombocytopenia" Poster:

SuppreMol press release. "SuppreMol's SM101 shows a sustained clinical activity and a favorable safety profile in Primary Immune Thrombocytopenia (ITP) patients.":



Veltuzumab (anti-CD20) is designed to deplete B-cells, a type of white blood cell. It works in the same manner as rituximab but differs in some structures and functions. It is given as an injection under the skin, not as an infusion. Of the 40 participants in the veltuzumab clinical trial, 68% had some response. The response was independent of the dose, the dosing schedule, or the length of time someone had ITP. There were no serious side effects or safety concerns.

622 "Phase I/II Study of Monotherapy with Subcutaneous Injections of Low-Dose Anti-CD20 Veltuzumab in Relapsed Immune Thrombocytopenia"


Understanding ITP



Lifestyle, genetics, and/or environmental exposure may influence the cause and course of ITP, but little is known about the specifics. PDSA is funding a research study to help define which factors are most important. A preliminary questionnaire was given to 109 children and adults. Some initial results: the most frequent hazardous substances contacted were cleaning supplies and chlorinated water; more than half of respondents reported more stress than usual; nearly one-half reported an infection prior to diagnosis. The researchers are comparing the survey results with treatment response for the initial group and refining the questionnaire in anticipation of giving it to a much larger population of ITP patients.

2239 "A Survey of the Etiology of Immune Thrombocytopenia (ITP)"



Oxidative stress (more reactive oxygen than the body can dismantle) is associated with many diseases. Researchers analyzed the markers of oxidative stress in children with ITP and matched healthy controls. They found that all children with ITP had more oxidative stress than their healthy counterparts. Those children whose ITP continued for a longer time had more markers of oxidative stress than the children who recovered. These results confirm prior findings that oxidative stress is associated with ITP and anti-oxidant therapies may be a helpful treatment option.

3319 "The Role of Oxidative Stress in Pediatric Immune Thrombocytopenia"

Note: Many lifestyle changes, such as mind/body interventions and diet, can reduce the amount of oxidative stress in children and adults. See the complementary treatments section of the PDSA web site for information:



This e-newsletter is published by the Platelet Disorder Support Association, 133 Rollins Avenue, Suite 5, Rockville, MD 20852, phone 1-87-Platelet, fax: 301-770-6638, web:, e-mail:


Platelet E-News: November 28, 2012

This e-newsletter is a monthly publication of the Platelet Disorder Support Association. The information in this newsletter is for educational purposes only. For advice on your unique medical condition, please consult a health care professional.


ITP and Platelet Disorders Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine


Blood CellsITP and Platelet Disorders
Research and Treatments


Some people have low platelets because of their sensitivity to over-the-counter or prescribed drugs, called drug-induced thrombocytopenia. Researchers evaluated blood tests for drug-induced thrombocytopenia and compiled a list of drugs that are likely to cause low platelets. They are: quinine (treats malaria, also found in tonic water), quinidine (for abnormal heart rhythms), trimethoprim/sulfamethoxazole (antibiotic), vancomycin (kills bacteria in intestines), penicillin (antibiotic), rifampin (antibiotic), carbamazepine (controls seizures), ceftriaxone (antibiotic), ibuprofen (relieves pain and swelling, ex: Advil, Motrin), mirtazapine (anti-depressant), oxaliplatin and suramin (chemotherapies); the glycoprotein IIbIIIa inhibitors abciximab, tirofiban and eptifibatide; and heparin (anti-clotting agents).

For more information on drug-induced thrombocytopenia see PDSA's 'Warnings' page:

Arnold DM et al. "A systematic evaluation of laboratory testing for drug-induced immune thrombocytopenia." J Thromb Haemost. 2012 Nov 3.


Selective serotonin reuptake inhibitors (SSRIs), common types of antidepressants marketed under nearly 50 brand names (ex: Prozac,and Zoloft), can increase the risk of bleeding in the brain, according to new research that examined prior studies on the subject. While the increased risk is small, about 1 in 10,000 people per year, the findings are consistent and logical. SSRIs can reduce the ability of platelets to clot, can decrease the platelet count, and have been associated with bleeding in the stomach. An editorial about the research concludes: "these findings emphasize the importance of appropriate patient selection and avoidance of inappropriate prescribing, which assumes particular importance in patients at increased risk of (brain hemorrhage).

Norton A. "Antidepressants linked to risk of brain bleeds." Reuters. Oct. 17, 2012.

McGrath ER, O'Donnell MJ. "Estimating treatment effects in observational studies." Neurology. 2012;79:1844–1845.

Hackam DG, Mrkobrada M. "Selective serotonin reuptake inhibitors and brain hemorrhage: A meta-analysis." Neurology. 2012 Oct 30;79(18):1862-5.


Researchers knew that people with ITP had deficient T-regulatory cells (Tregs, a type of white blood cell) and that these cells increased upon remission. New research shows that people with ITP also have deficient B-regulatory cells (Bregs, another type of white blood cell) and these cells also increase with remission. Both Tregs and Bregs are involved in regulating autoimmunity by helping to determine whether something is a normal part of the body or a foreign invader. In addition to a lower number of Bregs in ITP, the Bregs that are present don't function normally. When ITP research subjects were given a thrombopoietin agent, both their Breg numbers and their functionality increased. This research raises many questions. Among them: Do all ITP therapies enhance Bregs? Is the increase in Tregs and Bregs a natural function of having more platelets?

Semple J. "Bregging rights in ITP." Blood, October 18, 2012 vol. 120 no. 16 3169.


People with ITP can have antibodies attached in two different places on platelets: glycoprotein (GP)IIbIIIa or GPIb. The location of anti-platelet antibodies affects how the body eliminates platelets and can make a difference in which treatments work best. In the past researchers found that IVig didn't work well in people with the GPIb antibody placement. Now they have determined that people with GPIb antibodies don't respond as well to steroids.

Li J et al. "Fc-independent phagocytosis: Implications for IVIG and other therapies in immune-mediated thrombocytopenia." Cardiovasc Hematol Disord Drug Targets. 2012 Oct 18.


Hospitals, Insurance and Medical CareHospitals, Insurance,
and Medical Care


About 180,000 people die each year and another 1.4 million are seriously hurt from hospital-induced infections and mistakes. That's the bad news. The good news is that you can help prevent hospital errors. Consumer Reports published suggestions for preventing problems during a hospital stay (free) and ranked hospitals on various safety criteria (subscription required). See the Consumer Reports' guide at:

Hospitals can obviously do more to prevent medical errors. Some recommendations are a simple as making patient safety a priority and sharing more information with patients and the public. You can access free hospital safety ratings at: and hospital ratings using Medicare data at:

Makary M. "How to Stop Hospitals From Killing Us: Medical errors kill enough people to fill four jumbo jets a week. A surgeon with five simple ways to make health care safer." Wall Street Journal. Sept. 21, 1012:


It is not easy to balance the pros and cons of various treatments for ITP. However, to make a good treatment plan for any disease, doctors need to fully understand patient preferences and the trade-offs patients would make. Many doctors think they are taking people's desires into account, but when closely examined, that is often not the case. To make sure the treatments are in line with patient values, researchers have some suggestions for doctors: fully understand the patient's preferences, adopt a mindset of scientific detachment, and include the patient as part of the decision team.

Huston M et al. "New Style and New Content for" NLM Tech Bull. 2012 Jul-Aug;(387):e5 (editor note added September 20, 2012Mulley AG et al. "Stop the silent misdiagnosis: patients' preferences matter." BMJ 2012;345:e6572.


MeditationGeneral Health and Medicine


Fruit juice, not just grapefruit juice, can prevent prescription drugs from working as intended. Fruit juice can inhibit organic anion–transporting polypeptides (OATP), proteins involved in breaking down drugs and getting them into the blood stream. Researchers tested orange and apple juice and found that even drinks containing small amounts of fruit juice hindered drug action. Because apple and orange juice are consumed in much larger quantities than grapefruit juice, this research shows that the juice/drug interaction could have a greater impact on medical practice.

Important Note: The OATP/fruit juice connection is especially important for people with ITP taking eltrombopag (Promacta®) since OATP is involved in metabolizing that drug.

Dolton MJ et al. "Fruit juices as perpetrators of drug interactions: the role of organic anion-transporting polypeptides." Clin Pharmacol Ther. 2012 Nov;92(5):622-30.

Takeuchi K et al. "Pharmacokinetics and hepatic uptake of eltrombopag, a novel platelet-increasing agent." Drug Metab Dispos. 2011 Jun;39(6):1088-96.


The Environmental Working Group has published its 2012 Shopper's Guide to Pesticides in Produce. This useful guide, available in a grocery-story-ready print version, lists vegetables that are most frequently contaminated with pesticides and those with the least contamination. This is helpful for people who want to reduce both their pesticide exposure and their food budget. View the guide at:

Important Note: Pesticides have been linked to increased platelet destruction. For more information about this and other environmental influences on platelet count see the 'Warnings' page.



This e-newsletter is published by the Platelet Disorder Support Association, 133 Rollins Avenue, Suite 5, Rockville, MD 20852, phone 1-87-Platelet, fax: 301-770-6638, web:, e-mail:


Platelet E-News: October 25, 2012

This e-newsletter is a monthly publication of the Platelet Disorder Support Association. The information in this newsletter is for educational purposes only. For advice on your unique medical condition, please consult a health care professional.


ITP and Platelet Disorders Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine


ITP and Platelet Disorders Research and Treatments



Researchers performed a detailed analysis of the blood, pre and post operation, of four people whose splenectomies were successful, four people whose spenectomies failed to raise their platelet count, and four people without ITP. They were searching for some blood protein that was different in those people who responded to splenectomy versus those who didn’t. The researchers found what they were looking for: haptoglobin (Hp), a protein that binds to free hemoglobin released by red blood cells. The Hp level of non-responders before the operation was significantly lower than those who responded or the healthy controls. The researchers then measured the Hp levels in a larger group of ITP patients and found that their theory predicted splenectomy success in about 80% of the cases.

Zheng CX et al. “Proteomics-based identification of haptoglobin as a favourable serum biomarker for predicting long-term response to splenectomy in patients with primary immune thrombocytopenia.” RJ Transl Med. 2012 Oct 7;10(1):208.


Trauma patients with severe bleeding given tranexamic acid had a lower death rate and a reduced risk of blood clots compared to the placebo group, researchers report in a study of 13, 273 patients in the UK. (Tranexamic acid halts the natural reactions that prevent blood clots.) The study authors conclude that tranexamic acid can be used safely in a wide variety of traumatic bleeding cases.

Here’s what ITP experts have to say about tranexamic acid: “Antifibrinolytic agents, such as oral or IV tranexamic acid and episilon-aminocaproic acid may be useful in preventing recurrent bleeding in patients with severe thrombocytopenia; however, the efficacy has not been evaluated by randomized trial in ITP patients. Tranexamic acid (1 g, 3 times daily orally) and episilon-aminocaproic acid (1-4 g every 4-6 hours [maximum dose, 24 g/d]) may be of special value in certain dental or surgical procedures.”

Roberts I et al. “Effect of tranexamic acid on mortality in patients with traumatic bleeding: prespecified analysis of data from randomised controlled trial.” BMJ 2012;345:e5839.

Provan D et al. “International consensus report on the investigation and management of primary immune thrombocytopenia” Blood. 2010 Jan 14;115(2):168-86.


Our bodies contain about 100 trillion microbes, most of them bacteria, and most of them living in the digestive tract. These microbes play a role in our adaptive immune system, the part of the immune system that disables harmful viruses and bacteria. When the beneficial bacteria living in the gut are modified by diet, antibiotics, or invading pathogens, the immune system can shift. This disturbance of the intestinal immune system can lead to various intestinal diseases and has been increasingly linked to immune-mediated diseases outside of the intestine such as rheumatoid arthritis, multiple sclerosis, and other autoimmune diseases.

Note: ITP is an autoimmune disease.

Maynard CL "Reciprocal interactions of the intestinal microbiota and immune system." Nature 489, 231–241, 13 September 2012.


Scientists have now identified nearly 4,000 different proteins in platelets, about 85% of the total platelet protein content. The platelet protein level can vary with age, disease state, and some medications. However, the scientists found that 85% of the platelet proteins were constant in blood donations from healthy subjects. Understanding all of the platelet proteins and their function will provide more information on the platelets' role in health and disease.

van der Meijden PE, Heemskerk JW, "Platelet protein shake as playmaker." Blood. October 11, 2012 vol. 120 no. 15 2931-2932.

Burkhart JM et al. "The first comprehensive and quantitative analysis of human functional protein composition allows the comparative analysis of structural and functional pathways." Blood. October 11, 2012 vol. 120 no. 15 e73-e82.


Hospitals, Insurance, and Medical Care


Doctors (105) and patients (13,564) in three hospitals participated in an experiment allowing patient access to physician notes via the Internet. In a follow-up survey, 99% of the patients wanted the doctors to continue sharing the notes. The majority of these patients felt more in control of their care, were more willing to adhere to medication recommendations, and wanted to be able to comment on their doctors' notes. The doctors involved reported little increase in the volume of e-mails and little increase in time spent answering questions in or outside of the office.

Delbanco T. "Inviting Patients to Read Their Doctors' Notes: A Quasi-experimental Study and a Look Ahead." Annals of Internal Medicine. 2012 Oct;157(7):461-470."

Meltsner M. "A Patient's View of OpenNotes." Annals of Internal Medicine. 2012 Oct;157(7):523-524.


The Web site, managed by the National Library of Medicine/National Institutes of Health, lists more than 130,000 clinical trials in all 50 states and in 179 countries. It now sports an updated home page with enhanced navigation features, new content on clinical research, more background information, and additional search assistance. The updated site also makes it easier for people to find the results of previous trials. See:

Huston M et al. "New Style and New Content for" NLM Tech Bull. 2012 Jul-Aug;(387):e5 (editor note added September 20, 2012).


General Health and Medicine


BPA, an organic chemical with properties similar to estrogen, has been used since the 1950s to line metal cans and harden plastic bottles, among other things. Researchers recently showed that BPA can also alter the part of the brain responsible for managing our response to fear and stress, which in turn can affect social behavior, especially in adolescence. In a study using rats, the animals exposed to BPA fed a diet rich in soy were anxiety free compared to the animals that did not eat soy.

"Soy Diet May Lessen Anxiety Effect Of BPA On Genes." MediLexicon. Sept. 10, 2012.

Patisaul HB et al. "Anxiogenic effects of developmental bisphenol a exposure are associated with gene expression changes in the juvenile rat amygdala and mitigated by soy." PLoS One. 2012;7(9):e43890. Epub 2012 Sep 5.


Nanoparticles are particles with one dimension 100,000 smaller than the diameter of a human hair. A variety of nanoparticles are increasingly used in packaging, clothing, cosmetics, medicine, sports equipment, and more. However little is known about the effect of these tiny particles on human health. Researchers tested the impact of one type of nanoparticle, cerium dioxide, on monocytes, a type of white blood cell. They found the nanoparticles crossed the cell membrane and increased the proteins that lead to cell death. "Given that monocytes are crucial for human immunity, the work suggests even at low doses CeO2 nanoparticles may have detrimental effects on human health."

We can expect to hear more about the safety of nanoparticles following a 2-day workshop on the subject held September, 2012, that attracted more than 100 participants.

"Cerium dioxide nanoparticles may lead to human immune cell death." Environmental Factor, National Institute of Environmental Health Sciences, October, 2012.

Hussain S et al. "Cerium dioxide nanoparticles induce apoptosis and autophagy in human peripheral blood monocytes." ACS Nano. 2012 Jul 24;6(7):5820-9.

Loose C. "Challenges persist in the critical task of determining safety of nanomaterials." Environmental Factor, National Institute of Environmental Health Sciences, October, 2012.



This e-newsletter is published by the Platelet Disorder Support Association, 133 Rollins Avenue, Suite 5, Rockville, MD 20852, phone 1-87-Platelet, fax: 301-770-6638, web:, e-mail:


Platelet E-News: September 27, 2012

This e-newsletter is a monthly publication of the Platelet Disorder Support Association. The information in this newsletter is for educational purposes only. For advice on your unique medical condition, please consult a health care professional.


ITP and Platelet Disorders Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine


ITP and Platelet Disorders Research and Treatments



ITP is one of more than 80 autoimmune diseases that collectively affect as many as 23.5 million people in the US. This summer four papers were published in the Journal of Autoimmunity increasing the evidence that the environment plays a part in the development of autoimmune diseases. The papers identified specific disease triggers such as silica, solvents, and smoking, useful animal models, and the need to study pesticides, especially those used in farms, since their use coincides with a greater prevalence of autoimmunity. The Environmental Autoimmunity Group, a part of the National Institutes of Health, is developing a system to identify additional environmental triggers for autoimmune diseases.

Loose C. "NIEHS workshop inspires new papers on autoimmunity." National Institute of Environmental Health Sciences. Environmental Factor, September 2012.


Physicians at the Cleveland Clinic have provided a great service by summarizing recent findings about the physiology, diagnosis, and treatment of ITP in adults. This seven-page article, available fee, is a valuable resource for doctors as well as patents. The article lists 58 references for those who want to dig more deeply into the subject.

Thota S et al. "Immune thrombocytopenia in adults: An update." Cleve Clin J Med. 2012 Sep;79(9):641-50. Full text at:


Rozrolimupab, a potential new treatment for ITP from Symphogen (a Danish company), is a combination of 25 manufactured antibodies that can attach to Rh+ red blood cells. This treatment for ITP is similar in action to the blood-derived anti-D products (ex. WinRho SDF). In a phase I/II trial of 61 patients with ITP, 62% of the patients at the maximum dose had an increased platelet count of at least 20,000 from baseline. The most common side effects were headache and fever in addition to the expected reduction in hemoglobin levels for this type of treatment.

Robak T et al. "Rozrolimupab, a mixture of 25 recombinant human monoclonal RhD antibodies, in the treatment of primary immune thrombocytopenia." Blood. 2012 Aug 20. [Epub ahead of print]

For more information about anti-D treatments see:


Doctors were running out of options to raise the platelet count of a 72-year-old Japanese man whose ITP was unresponsive to steroids, eltrombopag, danazol, and IVIg. His platelets responded somewhat to romiplostim (Nplate ®), but the dose was reduced because of the side effects, resulting in a platelet count that was still too low for the intended splenectomy. His doctors then added IVIg to the low-dose romiplostim and, much to their delight, the man's platelet count rose to 150,000.

Note: While a case study is not a rigorous demonstration of overall treatment efficacy, it points to an option that could be tested in a larger group of patients. It also reminds us that ITP treatments can (and have been) used together to achieve better results.

Mitsuhashi K et al. "Combined romiplostim and intravenous immunoglobulin therapy increased platelet count, facilitating splenectomy in a patient with refractory immune thrombocytopenic purpura unresponsive to monotherapy." British Journal of Haematology, 2012, 158, 798–801.


Hospitals, Insurance, and Medical Care


The number of preventable deaths for people under 65 in the US declined by 17.5% between 1999 and 2007. This may seem like good news, but it pales compared to the 30+% decline in preventable deaths for Germany, France, and the UK during the same time period. In the US preventable deaths for those with cancer declined at about the same rate as the European countries; but preventable deaths from strokes and high blood pressure decreased the percent gain. This UK report notes that the US spent about twice as much per person on healthcare as Western European countries in 2009 and suggests that timely and effective healthcare for everyone in the US could further reduce the number of preventable deaths.

Nolte E and McKee CM. "In Amenable Mortality—Deaths Avoidable Through Health Care—Progress In The US Lags That Of Three European Countries." Heath Affairs. 31,No. 9 (2012): 2114–2122.


Platelets present the number one infection risk in the US blood supply. Other types of blood cells can be refrigerated and still be effective, but to work platelets must be kept at room temperature, a condition that can encourage the growth of bacteria, especially for longer storage periods. About 150 hospitals have adopted a new test that can measure bacteria in platelets before infusion, in addition to measuring bacteria when platelets are collected. Other hospitals are not using the test because they feel the $25 to $35 cost-per-unit to test platelets is too high relative to the potential benefit. Since 2004 the rate of death from tainted platelets has improved with better collection procedures, but there are still hundreds of cases of sepsis and some deaths annually due to bacterial contamination. Patients can help protect themselves from receiving tainted platelets by asking about the length of platelet storage, the type of testing, and whether the platelets come from a single donor or are pooled from many.

Landro L "The Biggest Blood Supply Risk: Tainted Platelets." Wall Street Journal. July 30, 2012.

Landro L. "Cutting the Risk of Tainted Platelets." Wall Street Journal. July 31, 2012.


General Health and Medicine


Everyone born between 1965 and 1945 should have a one-time hepatitis C test, according to the Centers for Disease Control. Why? Because the CDC looked at the deaths from hepatitis C and found that three-fourths of them occurred in baby-boomers. From three to four million people in the US have hepatitis C and don't know it. Treating the disease could improve their health.

Note: For people with ITP having a hepatitis C test is especially important since low platelets can be associated with a hepatitis C infection and clearing the infection can improve the platelet count. Taking prednisone is not advised for people with low platelets associated with hepatitis C.

Smith BD et al. "Morbidity and Mortality Weekly Report (MMWR): Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945–1965." Centers for Disease Control Recommendations and Reports. August 17, 2012 / 61(RR04);1-18.


Don't smoke, exercise, and participate in a social network. These three practices added years to lives according to researchers in Sweden when they compared the longevity and lifestyle of 1661 seniors. People in all age groups examined, including the oldest participants and those with chronic diseases, lived longer when these routines were part of their life.

For information on the impact of some lifestyle factors on ITP see the complementary treatment section of the PDSA web site:

Rizzuto D et al. "Lifestyle, social factors, and survival after age 75: population based study." BMJ. 2012 Aug 29;345:e5568:



This e-newsletter is published by the Platelet Disorder Support Association, 133 Rollins Avenue, Suite 5, Rockville, MD 20852, phone 1-87-Platelet, fax: 301-770-6638, web:, e-mail:


PDSA E-News: August 28, 2012

This e-newsletter is a monthly publication of the Platelet Disorder Support Association. The information in this newsletter is for educational purposes only. For advice on your unique medical condition, please consult a health care professional.


ITP and Platelet Disorders Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine


ITP and Platelet Disorders Research and Treatments



Some people in the clinical trials for the new TPO treatments developed blood clots. This finding prompted a number of studies to determine if the TPO agents are causing the problems or if people with ITP are just more susceptible to blood clots because of something inherent in the disease. In one study of people who took TPO agents, researchers in New York used a D-dimer test to determine if their subjects' veins were showing signs of blood-clotting activity. They found that the D-dimer levels of more than half of the ITP patients were above the upper range even before they took the TPO drugs and showed little change, usually downward, when on a TPO treatment.

A Danish study examining years of hospital medical records found that people with chronic ITP had more blood clots in their arteries than the general population. Women with chronic ITP were twice more likely to get blood clots in their arteries as women without the disease. For men the rate was about the same.

Ghanima W et al. "Venous thromboembolism and coagulation activity in patients with immune thrombocytopenia treated with thrombopoietin receptor agonists." Br J Haematol. 2012 Jul 23.

Nørgaard M et al. "Risk of arterial thrombosis in patients with primary chronic immune thrombocytopenia: a Danish population-based cohort study." Br J Haematol. 2012 Jul 23.

For more information on the TPO treatments see:


People with ITP don't have as many T-regulatory cells (a type of white blood cell) as others without the disease. Now researchers in Canada know why. According to Dr. John Semple, lead author of a new study and PDSA medical advisor, "instead of being released into the body where [the T-regulatory cells] are needed to prevent us from becoming autoimmune, they are being held up in the thymus." Perhaps a new way to treat ITP is to target the thymus (a small organ located in front of the heart and behind the breast bone) and find something that releases the T-regulatory cells.

"Research Sheds New Light on Common Bleeding Disorder." Insciences OrganisationPress Release. July 24, 2012.

Aslam R et al. "Thymic retention of CD4+CD25+FoxP3+ T regulatory cells is associated with their peripheral deficiency and thrombocytopenia in a murine model of immune thrombocytopenia (ITP)." Blood. 2012 Jul 3.


In addition to T-cell problems, the regulatory B-cells (another type of white blood cell) in people with ITP are also impaired. Researchers in New York found the regulatory B-cells in non-splenectomized people with chronic ITP are not performing their normal task of halting cell destruction very well. However, some of the regulatory B-cell functionality was restored in those patients when they were given a TPO agent.

Li X et al. "Defective regulatory B cell compartment in patients with immune thrombocytopenia (ITP)." Blood. 2012 Aug 2.


Researchers are making some progress if figuring out which people have a better chance of responding to particular treatments for ITP. This is welcome news to those who are tired of trying many treatments that ultimately fail. The bottom line is that the subtle differences in our genes and the proteins they trigger can influence how we respond to treatments and to the course of the disease. Here are two examples of the ways researchers are using genetics to help predict treatment outcomes.

The genes of children who respond to corticosteroids or develop chronic ITP are slightly different from those who respond to IVIg or recover more quickly. Researchers in Taiwan compared the detailed makeup of the human leukocyte antigen (HLA) collection of genes (genes important in controlling the immune system) in ITP patients to healthy controls. Specifically, "patients with HLA-DRB1*11 or -DRB1*15 were more likely to respond poorly to corticosteroids than IVIG." Children with HLA-DRB1*08 were less likely to develop chronic ITP.

In a study examining the characteristics of people responding (or not) to rituximab (Rituxan ®) people with the FCGR3A V/V genetic type were more likely to respond to rituximab. Those who had very high levels of CD8 (proteins that work with T-cells) didn't respond despite a drop in anti-platelet antibodies.

Ho WL et al. "Clinical features and major histocompatibility complex genes as potential susceptibility factors in pediatric immune thrombocytopenia." J Formos Med Assoc. 2012 Jul;111(7):370-9.

Cooper, N. et al. (2012), "Platelet-associated antibodies, cellular immunity and FCGR3a genotype influence the response to rituximab in immune thrombocytopenia." Br J Haematol. 2012 Aug;158(4):539-47.


Hospitals, Insurance, and Medical Care


Very….if you are tracking the sodium levels. Researchers found about twice the amount of sodium (salt) in patient-selected menus than the recommended 1,500 mg/day when they analyzed both the regular and diabetic meals at three hospitals in Canada. All of the standard menus exceeded the recommended level of sodium and about half of the patient-selected menus for those on a sodium-restricted diet exceeded their limits. Limiting sodium levels is an important public health priority since a number of chronic diseases are linked to excess sodium consumption.

Arcand J et al. "Evaluation of Sodium Levels in Hospital Patient Menus." Arch Intern Med. 2012 Jul 16:1-2.


The National Institutes of Health will spend $145 million over the next seven years to help patients with undiagnosed diseases. About 6% of the US population has a rare disorder and many remain a mystery or are very difficult to diagnose. The Undiagnosed Diseases Program (UDP) will set up a new network of medical research centers that will use recent advances in genomics to help diagnose and identify the underlying mechanisms of these cases. This will increase the understanding of these diseases and, hopefully, speed the development of therapies.

"NIH Common Fund announces new programs." National Institutes of Health Press Release, July 2, 2012.

Note: PDSA has heard from people whose low platelets seem to be due to unknown factors.


General Health and Medicine


Paxil, one of the brand names for paroxetine, a type of selective serotonin re-uptake inhibitor (SSRI), was responsible for prolonging a patient's ITP according to a recent case study. In that study the person's platelets went up after discontinuing the drug. This is just one person's experience but it reminds us that prescription drugs, as well as other substances, can affect platelet count and function. For more information on this subject see PDSA's "warnings page" at:

Ono S et al. "Prolongation of idiopathic thrombocytopenic purpura associated with paroxetine administration." Gen Hosp Psychiatry. 2012 Jul 23.


The mix of bacteria in your intestinal tract is important for a healthy immune response. The wrong combination of gut microbes could possibly shift the balance of the immune system and cause an autoimmune reaction for susceptible individuals. Overuse of antibiotics, disinfectant soaps, and processed food can alter the mix of gut bacteria.

"Host-Specific Microbiota Appears To Be Critical For A Healthy Immune System" Medical News Today, June 25, 2012.



This e-newsletter is published by the Platelet Disorder Support Association, 133 Rollins Avenue, Suite 5, Rockville, MD 20852, phone 1-87-Platelet, fax: 301-770-6638, web:, e-mail:


Platelet E-News: July 27th, 2012

This e-newsletter is a monthly publication of the Platelet Disorder Support Association. The information in this newsletter is for educational purposes only. For advice on your unique medical condition, please consult a health care professional.


ITP and Platelet Disorders Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine


ITP and Platelet Disorders Research and Treatments



Prednisone remains the first-line treatment for ITP, but when prednisone fails, and it often does, there is little agreement on what to do next. In years past, there was much agreement…it was prednisone then splenectomy, with little variation. However, with the advent of the thrombopoietin mimentics (NPlate®, Promacta®) and the increased use of rituximab (Rituxan®, MabThera®), the choice is much less clear. Unfortunately, there have been no studies directly comparing the outcomes of these new options to splenectomy or to each other. "As each approach has advantages and disadvantages treatment needs to be individualized, and patient participation in decision-making is paramount."

Ghanima W et al. "How I treat immune thrombocytopenia (ITP): the choice between splenectomy or a medical therapy as a second-line treatment." Blood. 2012 Jun 26.

Read the entire article at


Rituximab (Rituxan®, MabThera®) was approved in 1997 to treat B-cell non-Hodgkin lymphomas and administered at a dose of 375 mg/m2 once weekly for four weeks. Years ago when an adventuresome doctor tried an experiment using rituximab on his ITP patient, he used the same dose. In time, more and more doctors mimicked the first success of rituximab for ITP and the lymphoma dose became the usual way of treating the disease. But ITP isn’t B-cell non-Hodgkin lymphoma, so a few researchers have been experimenting with a lower dose (100/mg/m2 for four weeks) for their ITP patients and publishing their results. The most recent study using this lower dose is from China were researchers found that people with ITP treated with 100mg/m2 have nearly comparable rates of success as those treated with the higher lymphoma dose.

Li Y et al. [Clinical efficacy of lower dose rituximab for chronic refractory immune thrombocytopenic purpura]. Zhonghua Xue Ye Xue Za Zhi. 2012 Mar;33(3):204-6.

For more information about rituximab as a treatment for ITP and links to other research using the lower dose see:


Stopping excessive bleeding is a big worry for people with ITP. And it is also a huge problem in operating rooms, at the scene of accidents, and on the battlefield. Fortunately scientists at the Massachusetts Institute of Technology have developed a new bleed-halting product that works much better than those currently available: sponges sprayed with nano-particles composed of very small bits of thrombin (a blood-clotting protein) and tannic acid (an anti-bacterial substance found in black tea). These new sponges are easy to transport and can stop bleeding almost instantly, giving them a big advantage over other methods that require thrombin to be placed on a sponge at the time of use or tourniquets which can't be used on the neck. In a controlled test on a severely injured pig, the new sponges stopped bleeding much faster than other methods.

Sarao A. "Nanoscale Biocoatings to Stop Bleeding in Seconds." The Epoch Times. June 17, 2012.


Parsley has been used for years as a folk remedy for water retention, coughs, allergy, autoimmune, and chronic inflammatory disorders. Although it is one of the most potent disease-fighting plants little is known about how parsley works its magic….that is, until now. Recently, scientists set out to examine just one of the many wonders of parsley, its immune effects, in rigorous scientific detail. They looked at how parsley oil interacts with T-cells and B-cells (both types of white blood cells) and macrophages (cells that engulf and eliminate other cells). Conclusion: parsley oil acted in a similar way to drugs that suppress the immune system, like prednisone, but without the harmful side effects. As if that weren't enough, other studies have shown that parsley has antitumor, antibacterial, and antioxidant properties.

Karimi MH et al. "Parsley and immunomodulation." Expert Rev Clin Immunol. 2012 May;8(4):295-7.


Hospitals, Insurance, and Medical Care


Now it's official. With the passage of the FDA Safety and Innovation Act, the FDA will be implementing a plan (due October, 2013) to include more patient input in their approval process and provide a better explanation of the risk/benefit tradeoffs of the drugs they approve. To be fair, the FDA has been working on this plan (they call it a framework) and implementing part of it for a while. They recognized that the priorities of sick people may be very different from the priorities of the healthy reviewer and also saw a need to be more transparent in their approval process. More good news: the approval explanations will be in words, not obscure statistics.

Maxmen A. "Law spurs regulators to heed patients' priorities: US FDA to consider risks and benefits more explicitly in drug approvals." Nature. 10 July 2012.

USA.GOV: More Health Info on the Web

The US government has several agencies devoted to helping people lead a healthier life…FDA, NIEHS, NIH, CDC… each with its own acronym, purpose, Web site, and way of organizing information. Recently the government updated the Health and Nutrition section of the Web site to make it easier to find material across the array of government agencies. To see this process in action go to or just explore


General Health and Medicine


Low platelets do not protect people from heart and blood vessel problems so it is important for everyone to pay attention to their cardiovascular health. A Japanese study found that people who had a higher intake of magnesium in their diet also had a reduced risk of cardiovascular disease and men had a reduced risk of strokes caused by bleeding in the brain. However, other studies show that magnesium only reduces strokes caused by blood clots. Whichever type of stroke it reduces, getting enough magnesium in your diet is a good thing since it improves overall cardiovascular health. Be sure to eat plenty of green leafy vegetables, nuts, seeds, and beans to boost your intake of this important nutrient.

Zhang W et al. "Associations of dietary magnesium intake with mortality from cardiovascular disease: the JACC study. Atherosclerosis. 2012 Apr;221(2):587-95."


Going for a swim? According to the National Resources Defense Council our public beaches continue to be polluted and put bathers at risk. You can check to learn more about the contamination rating of the beach or great lake near you.

Cooling off with a soda? The formula for Coca-cola was recently changed in California to contain smaller amounts of the cancer-causing chemical 4 methylimidizole (4-MI) after the state required a cancer warning for the previous formula. However, the levels of 4-MI in Cokes sold in other states and in other countries remains high. The carcinogens come from processing the caramel color used to darken the drink, so Pepsi and perhaps other sodas have the same problem.

Slathering on the sunscreen? Only one in four sunscreens earns high marks for being safe and working well. Some can actually promote cancer, disrupt the endocrine system, or prompt an allergic reaction. You can check the safety of your favorite sunscreen or find a new one at

Firing up the grill? No one wants a dirty grill so most people scrub the rungs with a wire brush. But beware: the wire bristles can stick to the grill and be caught in the next batch of burgers. Eating the bristled food can cause huge problems such as puncturing parts of the gastrointestinal tract.

"Tests Show Carcinogen Levels in Coca-Cola Vary Worldwide: Coca-Cola Sold in Brazil is Most Contaminated." Center for Science in the Public Interest.

"Injuries from Ingestion of Wire Bristles from Grill-Cleaning Brushes — Providence, Rhode Island, March 2011–June 2012." Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. July 6, 2012 / 61(26);490-492.



This e-newsletter is published by the Platelet Disorder Support Association, 133 Rollins Avenue, Suite 5, Rockville, MD 20852, phone 1-87-Platelet, fax: 301-770-6638, web:, e-mail:


Platelet E-News: June 27th, 2012

This e-newsletter is a monthly publication of the Platelet Disorder Support Association. The information in this newsletter is for educational purposes only. For advice on your unique medical condition, please consult a health care professional.


ITP and Platelet Disorders Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine


ITP and Platelet Disorders Research and Treatments




Dioxin is a common pollutant found in cigarette smoke, the fat of some animal food sources, and other places. Scientists have found that dioxin can change the immune system and a mother can pass these changes to her children. Specifically dioxin can change CD8+ T-cells, a type of white blood cell important in regulating the immune response. Exposure to dioxin can also increase inflammation.

This information is important for people with ITP since CD8+ T-cells have been shown to impair the ability of the bone marrow to produce platelets and ITP is considered an inflammatory disease.

King H. "Seminar addresses developmental origins of immune disease." Environmental Factor. June 2012.

"Dioxins and their effects on human health." World Health Organization

Scherer L. "Megakaryocyte apoptosis a novel therapeutic target in ITP management." MedWire News. November 7. 2007.

Imbach P. "Oxidative stress may cause ITP." Blood. 2011 Apr 28;117(17):4405-6.


A recently published case report of Pappenheimer bodies in the red blood cells of someone who had a splenectomy, along with other medical conditions, reminds us of a condition known to some researchers for many years but largely unknown among patients. That is, small bits of iron can collect in the red blood cells of splenectomized people, iron which can only be seen if the blood is stained using a Wright stain. Alwin Max Pappenheimer first described this phenomenon in a paper published in 1945.

A more well-known change to red blood cells following splenectomy are inclusions of bits of DNA called Howell-Jolly bodies, seen as purple spots on the standard blood stain.

Lesesve JF et al. "Multiple Pappenheimer bodies after Splenectomy." Eur J Haematol. 2012 May 16.

Sears DA, Udden MM. "Pappenheimer Bodies: A Brief Historical Review." American Journal of Hematology 75:249–250 (2004).


To determine the number of people diagnosed with primary ITP at a given time (prevalence), researches in Oklahoma contacted 93 hematologists and tracked the number of patients who were given a diagnostic code of ICD-9-CM 287.3 (primary thrombocytopenia). Eight-seven physician offices responded with details. The results showed an average annual prevalence of 8.1 per 100,000 people for children and 12.1 per 100,000 people for adults. Men over 80 years old had the highest prevalence.

Note: While this study was carefully designed, the prevalence of ITP could be higher than these statistics show if they included secondary ITP and ITP patients who see heath care providers other than those answering the survey.

Terrell DR. "Prevalence of primary immune thrombocytopenia in Oklahoma." Am J Hematol. 2012 May 14.


Nearly 273,000 people were given oral corticosteroids (ex. prednisone) in the UK between 1990 and 2008. Compared to people with the same diseases but treated differently, the corticosteroid group had nearly seven times the rate of attempted or successful suicide and increased rates of depression, mania, delirium, confusion, disorientation, and panic disorder. Younger people were more susceptible to suicide attempts and older men were more apt to have delirium/confusion/disorientation and mania. Researchers suggest that physicians educate patients and their families about these risks and closely monitor that aspect of their care.

Fardet L et al. "Suicidal Behavior and Severe Neuropsychiatric Disorders Following Glucocorticoid Therapy in Primary Care. Am J Psychiatry. 2012 May 1;169(5):491-7.


Hospitals, Insurance, and Medical Care


No matter what the US Supreme Court decides about the 2010 healthcare law, one trend seems certain: companies will continue to move to high-deductible healthcare insurance plans for their employees. While these plans are sometimes called "consumer-driven," these plans reduce costs for employers and can increase costs for employees, especially those with chronic diseases. In some cases they can prompt employees to pay more attention to preventive services and shop for lower-cost providers. Unfortunately, they can also delay people from seeking needed care.

Hancock J. "High-deductible insurance plans become more common." The Washington Post, June 2, 2012.


The Centers for Disease Control recently released a 583-page report on the state of health in the US as of 2011, a report containing charts and statistics by age, gender, disease, socioeconomic status, location, and ethnicity. In general, people are getting fatter, still smoking, and not getting enough exercise, but are living slightly longer than in 2000. People in rural areas smoke more, have more disabilities, and are more likely to delay healthcare and be uninsured. The average per person expenditure on healthcare was $8,000 in 2009.

"Health, United States, 2011," Centers for Disease Control, May 16, 2012.


General Health and Medicine


You probably already know many of the things that can help prevent cancer….stop smoking, eat more vegetables, get more exercise, reduce radiation exposure, etc. There have been many studies that demonstrate the positive effects of these lifestyle changes. They are not mysteries. So why are people still dying of smoking-induced lung cancer and other preventable cancers? According to the study's authors, it will take a coordinated effort, education programs, a change in focus to prevention, and a belief in their worth, among other things, to have more of these healthy lifestyle practices meet their potential in preventing cancer.

"More than half of cancers may be preventable using existing resources." HemOnc Today, May 25, 2012.

Colditz GA. "Applying What We Know to Accelerate Cancer Prevention." Sci Transl Med. 28 March 2012: Vol. 4, Issue 127, p. 127rv4.


New research shows that statins, drugs prescribed to reduce cholesterol, can contribute to fatigue. In a study of 1062 men and women without cardiovascular disease given Zocor®, Pravachol®, or a placebo, from 20% to 40% of people on statins experienced general fatigue and fatigue upon exertion, with women more prone to these effects.

Note: Many people with ITP already experience fatigue. Statins can interact with eltrombopag, interfere with platelet function, can promote bleeding in the brain for those who have had a previous brain bleed, can promote muscle pain, and have an effect on T-cells (ITP is a T-cell mediated disease),

Golomb BA et al. "Effects of statins on energy and fatigue with exertion: Results from a randomized controlled trial. Arch Intern Med 2012.



This e-newsletter is published by the Platelet Disorder Support Association, 133 Rollins Avenue, Suite 5, Rockville, MD 20852, phone 1-87-Platelet, fax: 301-770-6638, web:, e-mail:


Platelet E-News: May 24th, 2012

This e-newsletter is a monthly publication of the Platelet Disorder Support Association. The information in this newsletter is for educational purposes only. For advice on your unique medical condition, please consult a health care professional.


ITP and Platelet Disorders Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine


ITP and Platelet Disorders Research and Treatments



 An analysis of the antibody levels of nearly 500 ITP patients demonstrated two intriguing patterns. Those with higher levels of IgA (immunoglobulin A) than most people did not respond as well to the usual first-line treatments of ITP (steroids, IVIg, and anti-D) and had an increased risk of bleeding. People with a lower level of IgM (immunoglobulin M) than the standard also didn't respond as well to the usual first-line treatments and, in addition, had a decreased response to splenectomy. The authors conclude: "These observations suggest that immune dysregulation as represented by elevations in IgA or decreased levels of IgM are associated with ITP that is more resistant to treatment."

Note: IgA antibodies are found in mucus secretions of the nose, mouth, digestive tract, and other areas of the body to protect against outside pathogens. IgM antibodies, the first responders to infection, are found mainly in the blood and lymph fluid.

Arnason JE et al. "Abnormalities in IgA and IgM are associated with treatment-resistant ITP." Blood. 2012 Apr 6.


The five-year response rate for rituximab (Rituxan®) was 21% in adults and 26% in children according to a research study analyzing the long-term success of 75 ITP patients who had a one-year response to the treatment. Both adults and children had about the same initial response rate to rituximab, 57%. Children who had a two-year response to rituximab generally continued to do well, whereas adults were more prone to relapse after that time period. Splenectomy status had no bearing on the response rate. Dr. James Bussel, a study author, suggests his next step is to combine rituximab with dexamethasone, a steroid, to try to help boost the response rate.

Note: Rituximab kills B-cells, the white blood cells responsible for creating the antibodies that attach to the platelets of people with ITP. For more information on the treatment see

Press Release "Rituximab Promotes Long-Term Response for Patients with Immune Destruction of Platelets." American Society of Hematology. May 7, 2012.

Patel VL et al. "Outcome at 5 years following response to rituximab therapy in children and adults with immune thrombocytopenia (ITP)." Blood. 2012 May 7.


The cost-effectiveness of the thrombopoietin mimetic treatments, eltrombopag (Promacta®/Revolade®) and romiplostim (Nplate®) come under financial scrutiny because of their cost and potentially long-term treatment duration. In one research study, the authors conclude: "highly effective and well-tolerated medications such as romiplostim may reduce the healthcare resource utilization associated with ITP while improving patients' HRQoL [health-related quality of life]" To reach this conclusion the study took into account the cost of the adverse effects of current treatments as well as research showing that many people with ITP endure various physical and emotional hardships from the disease that may be relieved with an effective treatment.

On the other hand, researches in the UK, in a report for National Institute for Health and Clinical Excellence, concluded that the cost of eltrombopag did not meet their financial standards of an incremental cost-effectiveness ratio below £ 30,000 per quality-adjusted life-year, a measure of how well and how long a person will live given a treatment. This study compared the use of eltrombopag to a watch-and-rescue treatment scenario. Bleeding was the only adverse event considered.

Deuson R et al. "The Burden of Immune Thrombocytopenia in Adults: Evaluation of the Thrombopoietin Receptor Agonist Romiplostim." J Med Econ. 2012 Apr 26.

Boyers D et al. "Eltrombopag for the Treatment of Chronic Immune or Idiopathic Thrombocytopenic Purpura: A NICE Single Technology Appraisal." Pharmacoeconomics. 2012 Jun 1;30(6):483-95.

For more information on romiplostim, eltrombopag, and other thrombopoietin mimetics used to treat ITP see


Herbal remedies have been used in several countries to raise the platelets of people with dengue fever, a disease characterized by a high body temperature and low platelets. Scientists in the Philippines are closely examining the platelet-raising potential of the tawa-tawa plant (Euphorbia hirta) as well as its anti-viral and anti-inflammatory properties. They want to find specific compounds in the plant responsible for these actions and, if their testing is successful, use these compounds to develop new drugs. More than a quarter of the active ingredients for new drugs between 1981 and 2002 were isolated from natural products.

Marchadesch B. "Local Tawa-tawa herbs may cure tuberculosis, dengue." GMA News. April 12, 2012.

For more information on herbal remedies for ITP see


Hospitals, Insurance, and Medical Care


Obesity rates have more than doubled since 1980 and, if the trend continues, about 42% of the people in the US will be obese by 2030, according to a 462-page report from the Institute of Medicine. Instead of putting all the responsibility on the obese person to eat less and exercise more, the report suggests attacking the problem from multiple social and environmental angles. These include increasing the availability of healthy food, reducing the consumption of sugar-sweetened beverages, and making it easier to walk or bike to destinations. Schools, businesses, and the government would need to cooperate to solve the problem. Obesity is responsible for $190 billion in healthcare costs, one-fifth of healthcare spending, not including increased insurance premiums and lost productivity. To help promote the message the National Institutes of Health, the Institute of Medicine, and the Centers for Disease Control and Prevention worked with HBO to produce a film and documentary series on the subject, The Weight of the Nation, available free on (

Begley S. "Obesity Fight Must Shift From Personal Blame: U.S. Panel." Reuters. May 8, 2012.

Glickman D et al. "Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation." National Academies Press. 2012.

Press Release. "NIH research featured in HBO documentary series on obesity." National Heart Lung and Blood Institute. May 1, 2012.


After years of consuming an ever-increasing percent of total spending, healthcare costs have stabilized at 17.9% of the gross national product. In 2009 and 2010 healthcare spending grew 4%, the smallest increase in more than 50 years. Some of the reduced increase can be attributed to the recession. But other factors such as the rise in the number of high-deductible insurance plans, greater use of generic drugs, and an emphasis on accountable care (payment for quality, not quantity) may signal a more permanent downward shift. A one percent drop in the growth of Medicare spending per year could reduce the projected long-term federal deficit by more than 30%.

Lowrey A. "In Hopeful Sign, Health Spending Is Flattening Out." New York Times. April 28, 2012.


General Health and Medicine


Frequent dental x-rays were linked to twice as many cases of intracranial meningiomas, a type of brain tumor, in a study comparing the dental history of 1433 people with matched controls. Those who had x-rays yearly or more frequently as children were most susceptible. People who had x-rays using panorex films before age ten had an almost five-fold greater risk of developing a meningioma than those who didn't have dental x-rays.

Children are more susceptible to the adverse effects, including the possibility of cancer, of all types of x-rays including CT scans and procedures using radioactive dye. When considering an x-ray, it is important to think about the medical necessity and to be sure the dose is adjusted for the age of the child. The FDA recently updated their Web page on pediatric x-ray imaging, providing information for parents and physicians on radiation procedures for children. See:

Claus EB. "Dental x-rays and risk of meningioma." Cancer. 2012 Apr 10.


Listening to music can calm your anxiety, reduce stress, soothe pain, and improve hearing, heart health, and stroke recovery. But, it has to be music you like, the more melodic and joyful the better. Playing music, not just listening, can help as well. Music training in children and adults helps memory and brings more mental focus. Maybe Bob Seger was right when he wrote: "Still like that old time rock and roll/The kinda music just soothes the soul."

For more information on the benefits of music for people with ITP see

Chan AL. "Music And Health: 11 Ways Playing And Listening To Music Help Both Body And Mind." Huffington Post. April 11, 2012.



This e-newsletter is published by the Platelet Disorder Support Association, 133 Rollins Avenue, Suite 5, Rockville, MD 20852, phone 1-87-Platelet, fax: 301-770-6638, web:, e-mail:


Platelet E-News: April 27th, 2012

This e-newsletter is a monthly publication of the Platelet Disorder Support Association. The information in this newsletter is for educational purposes only. For advice on your unique medical condition, please consult a health care professional.


ITP and Platelet Disorders Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine


ITP and Platelet Disorders Research and Treatments


Corticosteroids (ex. prednisone) caused the most distress of the five ITP treatments listed in an on-line survey taken by 589 people from PDSA. Nearly 38% of those surveyed who took corticosteroids reduced the dose or stopped the therapy due to side effects. More than half of the corticosteroid users reported at least one highly bothersome side effect, a larger percentage than splenectomy, IVIg, anti-D (ex. WinRho®), and rituximab (ex. Rituxan®), the other treatments queried. This is the first survey to link ITP treatments, resultant distress, and the impact on reducing or stopping ITP medications.

You can view the results of the entire survey at

Brown TM, et al. "Patient-reported treatment burden of chronic immune thrombocytopenia therapies." BMC Blood Disord. 2012 Mar 22;12(1):2.


A starting dose of 12.5 mg of eltrombopag (Promacta®/Revolade®), with a maximum dose of 50 mg, was given to 23 Japanese ITP patients instead of the 50 mg starting dose and 75 mg maximum dose approved in the US and Europe. There had been reports that people of East Asian descent responded differently to eltrombopag and this study set out to confirm whether this was true. In the study, 60% of the Japanese patients given the reduced dose responded to the treatment and none responded to the placebo. Twenty-two percent responded to the lowest dose of 12.5 mg, confirming that lower doses of eltrombopag are appropriate in this population.

Tomiyama Y, et al. "A lower starting dose of eltrombopag is efficacious in japanese patients with previously treated chronic immune thrombocytopenia (ITP)." J Thromb Haemost. 2012 Mar 12.

For more information about eltrombopag and other treatments that prompt the bone marrow to make more platelets see:


Tranexamic-acid, an inexpensive compound that stops blood clots from breaking down, is being increasingly used to stop traumatic bleeding on the battlefield, in ambulances, and in emergency rooms. A ground-breaking 2010 clinical trial of trauma patients in 40 countries, Crash-2 (, showed that it saved lives by stopping bleeding. But some countries, notably the US, have been slow to adopt its usage. One recent study of the drug showed it was effective in those with intracranial hemorrhage due to traumatic brain injury and another study estimates that it could save 128,000 lives worldwide, 4,000 in the US.

Note: In his talk "Treatment Options That Can Reduce the Risk of Bleeding in ITP Patients" at the 2011 ITP Conference, Dr. Craig Kessler mentioned the possibility of using tranexamic-acid, along with many other options, to stop bleeding for those with ITP. His presentation is summarized in the Summer 2011 issue of The Platelet News.

McNeil, Jr. DG. "A Cheap Drug Is Found to Save Bleeding Victims." New York Times. March 21, 2012.

Perel P, et al. "CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage) intracranial bleeding study: the effect of tranexamic acid in traumatic brain injury, a nested randomised, placebo-controlled trial." Health Technol Assess. 2012 Mar;16(13):1-54.

Ker K, et al. "Avoidable mortality from giving tranexamic acid to bleeding trauma patients: an estimation based on WHO mortality data, a systematic literature review and data from the CRASH-2 trial." BMC Emerg Med. 2012 Mar 1;12:3.


In a five-year follow-up of 96 children from Norway, Finland, and Sweden who had ITP lasting more than six months, researchers found that 50% recovered from their ITP. Fewer than half required hospitalization during the 5 years and only about 10% had a serious bleeding episode. Younger children with sudden onset of the disease recovered earlier and had fewer difficulties. The researchers conclude: "Aggressive management can be restricted to the minority of children with continuing severe thrombocytopenia and frequent, clinically significant bleeding events."

Rosthøj S, et al. "Duration and morbidity of chronic immune thrombocytopenic purpura in children: Five-year follow-up of a Nordic cohort." Acta Paediatr. 2012 Mar 16.


Hospitals, Insurance, and Medical Care


Nine specialty societies representing 374,000 physicians each developed a list of five things that physicians and patients should question. Other specialty groups are also creating lists, all this in an effort to reduce unnecessary tests that significantly add to treatment costs and may even harm patients. Unnecessary treatments could account for one-third of the healthcare costs in the US. Policy changes, including the way insurance companies pay, are also helping to shift medical practice by reducing the incentive for physicians to order expensive tests. For a list of questionable practices see:

Rabin RC. "Doctor Panels Recommend Fewer Tests for Patients" New York Times. April 4, 2012.


The loss of employment between 2007 and 2010 was the main reason that the percent of children and working-aged adults covered by employer-based health insurance dropped from 63.6% to 53.5%, according to a new study. The percent of people covered is much lower for those close to the poverty level, in their early twenties, or with less education. However, well before 2007 the percent of those with employer-based health coverage was declining, most likely due to rising insurance costs. Findings of this study for the National Institute for Health Care Reform, a nonpartisan, nonprofit organization, are summarized in the research brief, "The Great Recession Accelerated Long-Term Decline of Employer Health Coverage," online at:

"Job Loss Biggest Driver of 10-Percentage-Point Drop in Employer Coverage from 2007-2010; Apart from Job Loss, Fewer Firms Offering and Workers Taking Up Coverage—Rising Costs Likely Cause." Health Systems Change News Release. March 15, 2012


General Health and Medicine


The American Heart Association lists seven lifestyle factors associated with reduced cardiovascular disease: not smoking; being physically active; having normal blood pressure, blood glucose, total cholesterol levels, and weight; and eating a healthy diet. Of the 44,959 adults tracked from various databases in a new study, fewer than 2% had the seven positive indicators. About one in three Americas die of cardiovascular-related diseases, making it the leading cause of death.

Note: Low platelets do not protect people with ITP from developing blood clots or other cardiovascular diseases. In fact, the platelets of people with ITP are more reactive and may form blood clots more easily than those without the disease.

Yang Q, et al. "Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults." JAMA. 2012 Mar 28;307(12):1273-83.


When the IL-6 level (a marker for inflammation) of older adults was measured after they were given a stressful mental test, the level of those who slept poorly was up to four times greater than the IL-6 of those who slept well. Poor sleepers also reported more stress, more loneliness, and more depression. Researchers eliminated other possibilities and determined that poor sleep alone was the cause of the increased inflammation in this study of 83 adults with an average age of 61. The level of IL-6 found in the poor sleepers was consistent with an increased risk of illness and death in this population.

Note: ITP is often associated with systemic inflammation. An increased level of IL-6 in ITP patients has been linked to fatigue.

Heffner KL, et al. "Sleep Disturbance and Older Adults' Inflammatory Responses to Acute Stress." Am J Geriatr Psychiatry. 2012 Feb 10.



This e-newsletter is published by the Platelet Disorder Support Association, 133 Rollins Avenue, Suite 5, Rockville, MD 20852, phone 1-87-Platelet, fax: 301-770-6638, web:, e-mail:


Platelet E-News: March 27, 2012

This e-newsletter is a monthly publication of the Platelet Disorder Support Association. The information in this newsletter is for educational purposes only. For advice on your unique medical condition, please consult a health care professional.


ITP and Platelet Disorders Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine


ITP and Platelet Disorders Research and Treatments


SuppreMol GmbH, a German company specializing in treatments for autoimmune diseases, announced the results of their phase Ib/IIa double-blind, placebo-controlled trial of SM101, a new and different treatment for ITP. The 36 patients tested showed a dose-dependent response to the treatment with those in the highest dosage group continuing to respond for at least three months after the medication was discontinued. Because of these positive results SuppreMol will continue to develop and test this treatment in ITP and other B-cell driven diseases. SM101 works differently from other ITP treatments on the market. It blocks the action of immune complexes, thereby reducing the autoimmune response and associated inflammation.

See for more information.

"SuppreMol releases positive interim Phase Ib/IIa results on SM101 in Primary Immune Thrombocytopenia (ITP) trials." PharmaLive February 14, 2012.


In a French study of 372,696 people taking glucocorticoids (including prednisone), the rate of attempted and committed suicides was almost seven times that of others with the same disease who were not taking the medication. Delirium and confusion were five times more prevalent, mania was quadrupled, and depression was twice as frequent in those on steroids. "Older men were at higher risk of delirium/confusion/disorientation and mania, while younger patients were at higher risk of suicide or suicide attempt. Patients with a previous history of neuropsychiatric disorders and those treated with higher dosages of glucocorticoids were at greater risk of neuropsychiatric outcomes."

Fardet L et al. "Suicidal Behavior and Severe Neuropsychiatric Disorders Following Glucocorticoid Therapy in Primary Care." Am J Psychiatry. 2012 Feb 17. [Epub ahead of print]


Nearly 4% of the 19,473 returning travelers who visited the outpatient travel clinic at the University of Munich between 1999 and 2009 were diagnosed with thrombocytopenia. The low platelets were most frequently associated with malaria, acute human immunodeficiency virus, dengue fever/dengue hemorrhagic fever (DF/DHF) and Epstein-Barr associated infectious mononucleosis. Travelers to Sub-Saharan Africa (malaria) and South/Southeast Asia (DF/DHF) had the highest risk.

Herbinger KH, et al. "Comparative study on infection-induced thrombocytopenia among returned travelers." Infection. 2012 Feb 17. [Epub ahead of print]


Calcium reduces the effectiveness of eltrombopag (Promacta), a pill that stimulates the bone marrow to produce platelets. That’s why adults are instructed to take eltrombopag on an empty stomach and wait four hours before consuming anything containing calcium. Now eltrombopag is being formulated as an oral suspension (liquid) for testing in children, so researchers wanted to determine if there was any difference between the calcium reaction to this new formulation and the pill version of the drug. In a study of healthy adults, the oral suspension entered the system more quickly than the pill. The effect of the new medication was delayed if taken with a high-calcium meal or two hours after the meal. The absorption delay was reduced if the liquid was taken two hours before the meal.

Wire MB et al. “A Randomized, Open-Label, 5-Period, Balanced Crossover Study to Evaluate the Relative Bioavailability of Eltrombopag Powder for Oral Suspension (PfOS) and Tablet Formulations and the Effect of a High-Calcium Meal on Eltrombopag Pharmacokinetics When Administered With or 2 Before or After PfOS.” In Clin Ther. 2012 Feb 13.
[Epub ahead of print]


Hospitals, Insurance, and Medical Care


Small decreases in tobacco use, preventable hospitalizations, and coronary heart disease were offset by increases in diabetes, obesity, and poverty, leaving the overall health of Americans basically unchanged according to "American's Health Ranking" annual report. Since 1996 the diabetes rate has doubledand for the first time ever there was no state with an obesity rate less than 20%. Vermont was ranked the healthiest state and Mississippi, for the tenth year in a row, was ranked last. For the full report see:

Johnson TD. "Nation's overall health not improving, assessment finds: Obesity, diabetes stalling U.S. progress." The Nation's Health February 2012 vol. 42 no. 1 1-18.


Beginning in 2011, the Affordable Care Act requires insurance companies to spend at least 80% of their premiums on medical care and quality improvement. This year insurance companies are required to notify customers of their percentages spent and send rebates if they did not meet the 80% target. Because of this legislative change, The US Department of Health and Human Services reports that customers will receive up to $323 million dollars in rebates.

"HHS ensures consumers get better value for their health insurance dollar: Administration actions saved consumers up to $323 million." HHS Press Release. February 16, 2012.


General Health and Medicine


People who used sleeping pills (hypnotics) were more than three times likely to die early and had a 35% overall increased risk of cancer according to a recent study. This was true of both the shorter and longer acting varieties of these drugs. People consuming as few as 18 pills per year had increased risk, with problems escalating with greater usage. This large study of more than 10,000 adults and more than 20,000 matching controls is the 19th study to show a relationship between sleeping pills and early death. In the study data from a large medical center from 2002 to 2007, zolpidem (ex. Ambien) was the most prescribed drug.

Kripke DF et al. "Hypnotics' association with mortality or cancer: a matched cohort study." BMJ Open. 2012 Feb 27;2(1):e000850.


Grapefruit juice may increase the active levels of some drugs and decrease the effectiveness of others, according to a newly updated page on the FDA web site. Sandimmune (cyclosporine, sometimes used to treat ITP) as well as some statins, anti-anxiety, anti-arrhythmia, and antihistamine drugs may be affected. This juice blocks CYP3A4, an enzyme in your digestive tract that regulates how much of a drug gets into your blood stream, causing more to circulate. Grapefruit juice can also block proteins in the body that transport drugs to cells, reducing the action of the drugs. Since people differ in the amount of enzymes and proteins in circulation, they may react differently to the juice.



This e-newsletter is published by the Platelet Disorder Support Association, 133 Rollins Avenue, Suite 5, Rockville, MD 20852, phone 1-87-Platelet, fax: 301-770-6638, web:, e-mail:

Subscribe to this RSS feed

BBB Cleveland logo GuideStar Seal NORD Member Badge 2018THSNA logo