TPO Levels Help with ITP Diagnosis and Predicting Response to TPO TreatmentsWhen thrombopoietin (TPO) levels were measured in 118 healthy volunteers and in 88 patients with abnormal platelet counts the average TPO level in healthy volunteers was 39 (7-99) pg/mL (picograms per milliliter). In the 88 patients with abnormal platelet counts, 39 had thrombocytopenia from platelet destruction and 49 had thrombocytopenia from low platelet production. For those with platelet destruction the average TPO level was 63 (48-98) pg/mL). Patients with low platelet production had much higher average serum TPO level of 706 (358-1546) pg/mL. Of 21 ITP patients treated with TPO receptor agonists those who had a TPO level > 95 pg/mL showed a lack of clinical response. Researchers concluded TPO levels help to distinguish between thrombocytopenia caused by low platelet production and that caused by platelet destruction. Also, elevated TPO levels in ITP patients may predict poor clinical response to TPO treatment.
Makar RS, Zhukov Os, Sahud MA, Kuter DJ. "Thrombopoietin levels in patients with disorders of platelet production: diagnostic potential and utility in predicting response to TPO receptor agonists." Am J Hematol, 2013 Dec; 88 (12): 1041-4.
http://www.ncbi.nlm.nih.gov/pubmed/23913253
(Editor's note: PDSA Medical Advisor, David Kuter, said the test to measure TPO levels is a blood test called "serum thrombopoietin level", done at Quest Laboratories. For hospitals it is a 'send out' test and has been covered by insurance. This was a retrospective study and the greatest utility in the test is in telling which patients have ITP (TPO levels normal) vs. which patients have other bone marrow issues (TPO levels vastly increased). He said more research is being done on this.)
Researchers compared relapse rates after > one-year remissions in 52 ITP patients (from 2003 to 2013) who were treated with steroids vs. anti-Rh(D) with/without steroids vs. rituximab with/without steroids. Remission was defined as a platelet count > 100,000/µL while relapse was defined as < 30,000/µL. Results showed 16 remissions beyond one year in 13 patients (some patients had more than one remission during the 10-year study) following treatment with steroids, anti-Rh(D) with/without steroids, or rituximab with/without steroids. Researchers concluded among patients who achieved long remissions of ITP, those treated with anti-Rh(D)-based therapy were most likely to have extended remission.
Varma, M and Grossbard, ML. "Comparison of distant relapse rates of immune thrombocytopenia in patients treated with steroids versus anti-Rh(D) with/without steroids versus rituximab with/without steroids," Blood, Oct. 21, 2013, Vol. 122, No 21 (4760).
http://bloodjournal.hematologylibrary.org/content/122/21/4760.short
Newly Discovered Mutation of "Fc receptor" Immune Protein May Help Scientists Develop Better Treatment for Autoimmune DiseasesResearchers discovered a new immune protein that influences autoimmune diseases like lupus. People with this genetic variant can express an additional immune system receptor, called an Fc receptor, on their B cells (cells that make antibodies). Previously scientists thought Fc receptors could only shut down antibody production but new findings indicate 15 percent of the world's population has this new kind of Fc receptor that can also activate antibody production. For instance, in a person with lupus the Fc receptor would create too many antibodies, resulting in attacks on healthy cells.
This new information could help doctors prescribe treatments specific to each patient and provide early warning of autoimmune disease. While recent therapies to treat autoimmune diseases have been aimed at decreasing activity of B cells, these treatments may not be effective for people who have the new Fc receptor variant. Dr. Robert Kimberly, study co-author, said, "This new finding could play a significant role in the way companies design treatments for autoimmune disease, in a more targeted approach." It will also save time and costs associated with clinical trials.
McNamee D, "New hope for lupus screening and treatment." Medical News Today, Jan. 20, 2014.
http://www.medicalnewstoday.com/articles/271456.php
"Newly identified immune receptor may activate B cells in autoimmunity." UAB News, Dec, 19, 2013.
http://www.uab.edu/news/latest/item/4010-newly-identified-immune-receptor-may-activate-b-cells-in-autoimmunity
Millions of patients take acid-suppressing medications called proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs). They shut down acid production in the stomach but may reduce levels of B12 absorption and increase risk for bone fractures. Well known PPIs include omeprazole (Prilosec®) and esomeprazole (Nexium®). Some H2RAs include: famotidine (Pepcid®) and ranitidine (Zantac ®). Researchers studied 25,956 patients with diagnosed vitamin B12 deficiency (January 1997 to June 2011).
Those treated for two or more years with PPIs or H2RAs had a 65 percent increased risk for vitamin B12 deficiency. B12 deficiency increases risk of dementia, nerve damage, anemia, and other problems. The researchers recommended patients on long-term acid-suppressing meds be screened for B12 deficiency and said B12 supplements are an effective treatment.
In a Swedish study researchers found older men with low levels of B12 were at increased risk for bone fractures. Those with low B12 levels were more likely to have suffered a fracture. Men with the lowest levels of B12 were about 70 percent more likely to have suffered a fracture (primarily lumbar spine) than others. It was not known if eating more foods with B12 such as eggs, fish and poultry would reduce fracture risk.
Kaiser Permanente. "Long-term use of common heartburn and ulcer medications linked to vitamin B12 deficiency." ScienceDaily, 10 December 2013.
http://www.sciencedaily.com/releases/2013/12/131210163612.htm
Lewerin C, Nilsson-Ehle H, et al. "Low holotranscobalamin and cobalamins predict incident fractures in elderly men; The MrOS Sweden." Osteoporosis International, 2014 Jan; 25(1):131-40.
http://www.sciencedaily.com/releases/2013/12/131210091244.htm
http://www.ncbi.nlm.nih.gov/pubmed/24129588
New Study Aims to Develop Improved Artificial PlateletsWith a $1.9 million NIH grant a Case Western Reserve University research team is collaborating with researchers at the Cleveland Clinic Foundation to develop injectable artificial platelets that would halt bleeding by sticking to bleeding sites and signaling natural platelets to be attracted to the site. While artificial platelet research has been ongoing the past 20 years, it mainly focused on 'clustering' mechanisms of platelets. This is the first research to integrate platelets' 'stickiness' function of sticking to an injury site by specific molecular interactions. Researchers say the new platelet design may be more effective in managing bleeding disorders compared to designs in the past. The study aims to uncover the details of how the stickiness and clustering work together to maximize clotting ability. http://phys.org/wire-news/155397095/cwru-wins-19-million-grant-to-lead-artificial-platelet-study.html
http://cwru-daily.com/news/cwru-wins-1-9-million-grant-to-lead-artificial-platelet-study/
Eltrombopag Increased Platelet Counts in Chronic ITP Patients Prior to SurgeryITP patients with low platelet counts face increased risk of bleeding during medical and surgical procedures. Treatment guidelines recommend a platelet count of at least 50,000/µL before minor surgery and at least 80,000/µL before major surgery. A retrospective analysis found that a majority of the chronic ITP patients who received eltrombopag (Promacta®) and who experienced increased platelet counts met current pre-procedural platelet count recommendations. Patients receiving eltrombopag also had reduced need for additional ITP treatment after the procedure. The study explored invasive, non-dental procedures associated with bleeding risk (hemostatic challenges) in 494 chronic ITP patients in five phase2/phase 3 studies of eltrombopag.
Tarantino M, Bakshi K, and Brainsky A. "Hemostatic challenges in patients with chronic immune thrombocytopenia treated with eltrombopag." Platelets, Feb. 2014; 25(1): 55-61.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3913069/
Is Your Hospital Safe?ITP patients have often been hospitalized as part of their treatment and care. But just how safe is your hospital? At least 440,000 Americans die each year from preventable medical errors in hospitals, according to a study in the Journal of Patient Safety. Changes to improve the situation include not only doctors, nurses and hospital staff but also increased participation by patients in their own health-care decisions. Patients need to ask questions and create a partnership with their doctor before they are in the hospital. The major problems that can be life-threatening include: diagnostic errors and receiving the wrong treatment, hospital-acquired infections, and surgery on the wrong body part.
http://www.everydayhealth.com/news/how-safe-your-hospital/
New Studies Show How Dark Chocolate Helps the Cardiovascular SystemWe've been hearing of the benefits of eating dark chocolate for many years but only recently scientists discovered the exact reasons why. First, in a study at Louisiana State University researchers report that certain good bacteria in the stomach gobble the chocolate and ferment it into anti-inflammatory compounds that are good for the person's heart. In a second study researchers found that dark chocolate helps restore flexibility to human arteries while preventing white blood cells from sticking to the walls of blood vessels. Arterial stiffness and white blood cell adhesion are known risk factors for atherosclerosis. So go ahead and enjoy some chocolate this spring.
American Chemical Society. "Precise reason for health benefits of dark chocolate: Thank hungry gut microbes." ScienceDaily. 18 March 2014.
https://www.facebook.com/sciencedaily/posts/432767973535095?stream_ref=10
"Why dark chocolate is good for your heart." Federation of American Societies for Experimental Biology (FASEB) Journal, February 2014.
Esser D, Mars M, Oosterick E, Stalmach A, et al. "Dark chocolate consumption improves leukocyte adhesion factors and vascular function in overweight men." FASEB J March 2014 28:1464-1473.
http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=32905
Activated platelets tend to aggregate (leading to clotting) but they cannot do so when the platelet numbers are low, as in ITP. Researchers examined platelet activation in 55 ITP patients and 55 controls, with and without ADP (adenosine diphosphate) stimulation both before and after the patients received steroid treatment. They found that platelets in ITP patients exist in an activated state. The fold activation of platelets treated with ADP was more in healthy controls than in ITP patients. Treatment with steroids caused platelets in steroid-responsive patients to respond more to the ADP activation. The researchers concluded steroids may cause changes in the ability of platelets to become activated with an agonist like ADP. Their results offer new insights into how steroid therapy aids in treating ITP.
Bhoria P, Sharma S, Varma N, Malhotra P, Varma S, Luthra-Guptasarma M. "Effects of steroids on the activation status of platelets in patients with immune thrombocytopenia (ITP)." Platelets. 2014 Mar 11.
http://www.ncbi.nlm.nih.gov/pubmed/24617442
B-cell depletion from rituximab treatment may impair vaccine responses and increase risk of infection in ITP patients. Researchers investigated the response to Streptococcus pneumonia vaccines given to 24 patients six months after they received rituximab treatment. The study found antibody responses to vaccines were impaired at least six months after rituximab. The findings showed importance of timing of vaccinations and the possible means of infection after ITP patients receive rituximab.
Nazi I, Kelton JG, Larche M, Snider DP, Heddle NM, Crowther, MA, Cook RJ, Tinmouth AT, Mangel J, Arnold DM. "The effect of rituximab on vaccine response in patients with immune thrombocytopenia." Blood 2013 Sep 12; 122(11):1946-53. http://www.ncbi.nlm.nih.gov/pubmed/23851398
Researchers have developed a new optical device about the size of a tissue box that provides rapid test results with only a small amount of blood. The technique, called laser speckle rheology (LSR), was found very sensitive to the coagulation of blood. It allows doctors to evaluate a patient's coagulation status in real-time especially in operating rooms, emergency departments, and intensive care units for patients with any type of coagulation disorder. This would aid doctors in quickly deciding how much blood to give to a bleeding patient. Clinical testing at the point of care is the next phase of research.
Tripathi M, et al, "Assessing Blood Coagulation Status with Laser Speckle Rheology," Biomedical Optics Express, Vol. 5, Issue 3, pp. 817-831 (2014).
http://www.opticsinfobase.org/boe/abstract.cfm?uri=boe-5-3-817
In the past, we learned how BPA (bisphenol A) a chemical used in the linings of canned food, plastics, and cash-register receipts could disrupt hormones and have adverse effects on humans and wildlife. Since then many companies switched to thermal paper cash-register receipts made with an alternative chemical, bisphenol S (BPS). Now recent research shows that BPS also disrupts the hormone estrogen, even at low levels. With BPS on receipts that we handle every day it is very easy to get residue on the fingers and hands. To reduce your exposure, always wash hands after handling receipts and throw them away if unneeded. Some stores now offer electronic, online receipts instead of paper.
http://www.scientificamerican.com/article/bpa-replacement-also-alters-hormones/?print=true
http://articles.mercola.com/sites/articles/archive/2012/06/20/bpa-free-plastic-still-toxic.aspx
What causes decreased platelet count in immune thrombocytopenia (ITP) is not entirely understood. Researchers in Argentina investigated the key step of proplatelet formation (PPF) by studying the effect of ITP plasma in thrombopoiesis. Megakaryocytes taken from cord blood were cultured along with recalcified plasma from ITP patients. The PPF was evaluated using microscopic analysis. The ITP patient samples caused a dose-dependent inhibition in PPF and decreased the complexity of the proplatelet structure. Results showed there is involvement of auto-antibodies in inhibiting thrombopoiesis. The findings indicate new mechanisms contribute to decreased platelet counts in ITP patients.
Lev PR1, Grodzielski M, Goette NP, et al. "Impaired proplatelet formation in immune thrombocytopenia: a novel mechanism contributing to decreased platelet count." Br J Haematol. 2014. Mar 27.
http://www.ncbi.nlm.nih.gov/pubmed/24673454
A Canadian study has found that currently available treatments for ITP are inadequate since they do not reverse the disease process and usually do not result in long-lasting remissions. Many of the treatments produce serious side effects including infection and potentially thrombosis (blood clots). New treatments being developed work differently from the current group. They target certain key steps in the ITP disease process. These include the platelet auto-antibodies, T-cells, and signals for platelet destruction. Targeted therapies for ITP patients could improve disease outcomes while limiting difficult side effects.
Shih A, Nazi I, Kelton JG, Arnold DM. "Novel treatments for immune thrombocytopenia." Presse Med. 2014 Apr;43(4 Pt 2):e87-95.
http://www.ncbi.nlm.nih.gov/pubmed/24656294
Military statistics show minimizing major blood loss within the first 10 minutes after traumatic injury is crucial to survival. Hemorrhage is the leading cause of battlefield deaths. Large deep wounds in the upper legs and torso are often difficult areas for applying an external tourniquet. Researchers have developed a pocket-sized syringe that can inject directly into the wound site a sealed barrier from tiny, pill-sized sponges made of sterile cellulose (wood pulp) coated with an antimicrobial clotting agent called chitosan. The sponges expand up to 15 times their size as they soak up blood and expand within the deep wound, clumping together to form a solid mass that prevents excessive bleeding while also speeding up clotting. The injectable sponges may soon be absorbable within the body as well. These would be quite effective for nosebleeds as well. The injectable dressings, if FDA approved, may be available this summer.
Nguyen T. "An Injectable Bandage Can Stop Heavy Bleeding in 15 Seconds," Smithsonian.com, Feb. 12, 2014.
http://www.smithsonianmag.com/innovation/injectable-bandage-can-stop-heavy-bleeding-15-seconds-180949723/?no-ist
This past summer the Center for Science in the Public Interest (CSPI), a food safety advocacy group, downgraded its rating for the artificial sweetener, sucralose (common trade name Splenda®) from "safe" to "caution", pending peer review of a study by an independent Italian lab that had found the sweetener caused leukemia in mice. CSPI said it awaits the Italian study's review before deciding what long-term safety grade to assign to Splenda. CSPI said previously the only long-term animal feeding studies had been done by the sucralose manufacturer. CSPI had already rated as "avoid" several other artificial sweeteners, including saccharin, aspartame, and acesulfame potassium. A sweetener obtained from the plant stevia is currently considered "safe" by CSPI. To help avoid risks of both sugar and artificial sweeteners, CSPI encourages people to make a healthy switch to water, seltzer, diluted fruit juices, unsweetened flavored waters, and unsweetened tea.
Nordqvist, C. "How Safe Is Splenda (Sucralose)?." Medical News Today. (2013, June 25). Retrieved from
http://www.medicalnewstoday.com/articles/262475
http://news.msn.com/us/splenda-goes-from-safe-to-caution-after-leukemia-found-in-mice
Each year the annual American Society of Hematology (ASH) meeting attracts thousands of clinicians and scientists from around the world to learn about and report on the latest hematology research. This year's meeting, held December 5 to 8 in Orlando, Florida, featured more than 10 hours of presentations and more than 65 pages of abstracts about ITP and related diseases. In this issue of the e-news, we report some of the trends.
The ASH abstract numbers are shown in parentheses. You can search on the number and read the complete abstract at: https://ash.confex.com/ash/2015/webprogram/start.html, after you 'agree' with the terms.
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