Platelet E-News – June 16, 2004

Contents:

  • ITP Medical Emergency Card
  • Too Much Dieting Harms Immune System
  • Cox-2 Drugs Linked to Stomach Bleeding
  • Platelet Antibody Tests Help Predict Chronic ITP
  • Treatment of Childhood ITP
  • Complementary and Alternative Medicine Use on the Rise
  • Would you like to postpone or avoid splenectomy (advertisement)
  • Herbal Treatment (advertisement)

 

ITP MEDICAL EMERGENCY CARD

The Platelet Disorder Support Association has printed a wallet-size medical emergency card designed for patients with ITP. It contains a space for personal, emergency contact, treatment, medical history and insurance information. To receive your medical emergency card, send a note and a stamped, self-addressed envelope to PDSA, P.O. Box 61533, Potomac, MD 20859.

We thank Nabi Biopharmaceuticals for sponsoring the printing of these cards and Morbus-Werlhof-Selbsthilfegruppe, the German ITP Association, for sharing their emergency card format.

TOO MUCH DIETING HARMS IMMUNE SYSTEM

Want to keep your immune system in tip-top disease-fighting shape? If you’re a woman, a new study suggests that immune health is best when your weight is stable but can be compromised by yo-yo dieting (repeatedly losing and regaining weight). Researchers at the Fred Hutchinson Cancer Research Center in Seattle interviewed a group of older women about their weight loss history over the past 20 years and theorized that healthy immune function declines with repeated weight loss (and gain). Women whose weight remained stable or those who had lost excess pounds and then maintained a constant weight had better natural killer-cell activity. (Killer cells are important in destroying viruses, detecting leukemia cells, and performing other cellular defenses.) The women who said they had lost and regained weight more than five times had natural killer-cell function approximately one-third lower than that of women whose weight remained stable. The results suggest that for the sake of your immune system you should get to a healthy weight and maintain it.

The study was published in the June 1, 2004, issue of the Journal of the American Dietetic Association

COX-2 DRUGS LINKED TO STOMACH BLEEDING

A new Canadian study links Cox-2 inhibitors (pain-relief drug) to increased risk of stomach bleeding. Last year a study published in the American Heart Journal (October 2003) raised the question of whether the Cox-2 inhibitors were safe to use in patients at risk for cardiovascular events. These drugs were thought to be gentler on the stomach but responsible for making platelets “stickier” and more likely to be responsible for clot formation in blood vessels. Now a retrospective Canadian study of health care data for elderly people suggests that the increase use of Cox-2 inhibitors and gastrointestinal bleeding are directly related. The study published in the British Medical Journal followed the observation that when the Ontario government began paying for the new generation of anti-inflammatory drugs, hospital admissions for stomach bleeding rose. Critics of the study point out that the data does not necessarily link the increased bleeding to patients taking the new drugs and that the new safer medications may have brought higher risk patients to use them. The study is in no way conclusive. More definitive conclusions await a large, prospective randomized trial.

Scott Hensley, Wall Street Journal, June 11, 2004, pB-1

PLATELET ANTIBODY TESTS HELP PREDICT CHRONIC ITP

Antibody testing has never proved useful as either a diagnostic tool or a predictor for ITP patients. However research reviewed by Douglas Cines, MD, in a recent issue of Blood raises the “possibility that measuring platelet-specific antibodies may be of use to prognosticate the clinical course in patients with an established diagnosis.” Several recent studies support this position and a large recently published study by McMillan and colleagues showed that “once patients with non-immune causes of thrombocytopenia who responded to ITP-directed therapy are excluded, the specificity of a positive antibody assay for the diagnosis of ITP approached 95%.” And finally, the study by Fabris and colleagues appearing in Blood in June of this year followed fifty consecutive patients and using a solid-phase modified antigen capture ELIAS test for the detection of specific platelet-associated autoantibodies against a number of glycoproteins demonstrated that “ITP patients with platelet autoantibodies ….. have a clinical worsening of thrombocytopenia more frequently and sooner that patients without autoantibodies.

Douglas Cines, “Antibodies Redux” Blood, June 15, 2004, p 4380.
Fabrizio Fabris and colleagues, “Platelet-associated autoantibodies as detected by a solid-phase modified antigen capture ELISA test (MACE) are a useful prognostic factor in idiopathic thrombocytopenic purpura” Blood, June 15, 2004, p 4562.

See: www.bloodjournal.org

TREATMENT OF CHILDHOOD ITP

“I believe that doctors often make matters worse in the way they manage this condition (ITP in children). They prescribe mostly unpleasant, frequently unnecessary and sometimes dangerous therapy. They also offer self-defensive and over-cautious advice on risk management, creating what amounts to an anxiety state in some patients,” says Dr. John Lilleyman in a note in a recent issue of the British Journal of Haematology. So often it is platelet count that is treated and the author points out that platelet count is a poor predictor of morbidity (life threatening condition). Turning to mortality he points out that, intracranial haemorrhage is effectively the only fatal complication, but even massive cerebral bleeds can be managed successfully with appropriate emergency measures and are by no means always fatal. Dr. Lilleyman concludes, “Outside the context of emergency treatment for life threatening bleeding … the effect of therapy on the mortality of childhood ITP remains to be determined but is probably close to zero. For morbidity, some measures, …. might improve the quality of life for the occasional child with chronic symptomatic thrombocytopenia by relieving disabling menorrhagia or self-consciousness, or by removing the straitjacket of fear. But heroic attempts to raise the
platelet count in otherwise well children seldom justify the risks involved.”

British Journal of Haematology, 2003, 123, 586-589

COMPLEMENTARY AND ALTERNATIVE MEDICINE USE ON THE RISE

Complementary and alternative medicine (CAM) use among Americans is on the rise. Seventy-five percent of adults 18 and over have used CAM, 62% during the past 12 months, when prayer specifically for health reasons was included in the definition. The data supporting the report is from the 2002 National Health Interview Survey (NHIS) conducted by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS). This level of use when compared with CAM use reported in earlier studies indicates, according to the report released by the U.S. Department of Health and Human Services, a substantial increase in CAM use during the 1990’s. The report attributes the increase to “marketing forces, availability of information on the Internet, the desire of patients to be actively involved with medical decision making, and dissatisfaction with conventional (western) medicine.” This dissatisfaction the report attributes to the inability of conventional medicine to adequately treat many chronic diseases. The report points out several characteristics these therapies have in common; including “the use of complex interventions; often involving the administration of many medications or medical substances at the same time; individualized diagnosis and treatment of patients; an emphasis on maximizing the body’s inherent healing ability; and treatment of the ‘whole’ person by addressing their physical, mental, and spiritual attributes rather that focusing on a specific pathogenic process as emphasized in conventional medicine.” The report also warns that use of these CAM therapies might have unanticipated negative consequences. Other studies have found that many patients do not share with treating physicians their use of CAM therapies; thus raising the possibility of negative consequences.

“Complementary and Alternative Medicine Use Among Adults: United States, 2002”, Patrick M. Barnes, et. al. The full report is available at www.nccam.nih.gov

(For more information on the use of CAM for ITP see the results of our PDSA 2001 survey of non-traditional therapies see www.pdsa.org/surveyres/ and www.itppeople.com/treatments.htm)

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