Platelet E-News – May 17, 2004

Contents:

  • New side-effects reported for three therapies used to treat ITP
  • HHS directs hospitals to discount to uninsured patients
  • Genes linked to chronic ITP in adults
  • Back to basics – Washing hands to prevent illness
  • Snake bite can cause low platelets
  • Embryonic stem cells: future approach to treatment?
  • New test to identify MDS
  • Herbal Treatment (advertisement)
  • How much time does your intravenous (IV) therapy take? (advertisement)
  • Immune Globulin Services Provided in Patients’ Homes (advertisement)

 

NEW SIDE EFFECTS REPORTED FOR THREE THERAPIES USED TO TREAT ITP

Chemotherapy and cognitive decline: Chemotherapy patients have long complained that the treatment caused cognitive decline. Imaging studies, presented last month at a scientific meeting in Florida, confirmed these complaints by showing marked differences in breast-cancer patients who had undergone chemotherapy compared to a group who had undergone surgery alone. While two-thirds of women treated with chemotherapy show some level of cognitive problems, most recover within weeks or months of treatment. Tim Ahles, at the Dartmouth Medical School, says 20% to 25% of patients may develop lasting problems. “For patients who need chemo, the problems are not significant enough to turn down treatment. But doctors say patients who are borderline candidates may want to factor the potential cognitive side effects when deciding whether to undergo chemotherapy.”

Wall Street Journal, Tara Parker-Pope, March 6, 2004, p D1. e-mail the author at healthjournal@wsj.com.

Steroid therapy as a risk factor for sigmoid diverticular abscess perforation (SDAP): Reuters Health Information Service reported recently on work done by Dr. S. Mpofu and colleagues that showed steroid therapy was strongly associated with the bowel condition while non-steroidal anti-inflammatory drugs were only weakly associated with SDAP. Corticosteroid is a risk factor for SDAP for patients with our without rheumatic disease.

Ann Rheum Dis 2004;63:588-590.

Immunoglobulin-secreting cells (ISC) persist in the spleen: Work by Julia I. Ellyard and colleagues has demonstrated the persistence of long-lived immunoglobulin-secreting cells (ISC) in lymph tissue and rodent spleens. To date, ISC were thought to reside only in the bone marrow. These findings suggest that the spleen may play an important role in maintaining humoral immunity (immunity conferred by antibodies). Identifying the human counterpart of rodent ISC will be valuable in investigating the long-term immunity of splenectomized patients.

BLOOD, 15 May 2003, Vol 103, Num10, pp3805-3812.

HHS DIRECTS HOSPITALS TO DISCOUNT TO UNINSURED PATIENTS

Historically hospitals have told uninsured patients that Medicare requires charging them at the highest rate. The Department of Health and Human Services (HHS) has now notified hospitals that there are no federal rules preventing them from offering discounts to uninsured patients. This is important, good news for the 43 million Americans without health insurance.

NORD, March 2004, p6.

GENES LINKED TO CHRONIC ITP IN ADULTS

Work by Takashi Satoh and colleagues examined the single nucleotide polymorphisms (SNPs) of inflammatory cytokine genes in 84 adult Japanese patients with ITP. They found that TNF-B (+252) G/G phenotype was significantly higher in ITP patients than in healthy controls. Their findings suggest that the SNP located at TNF-B (+252) contributes to the susceptibility of chronic ITP. “Other genetic and environmental factors are definitely necessary for the development of ITP as well, but the SNP at TNF-B (+252) may play a role in an individual’s susceptibility to this disease by promoting the specific autoantibody response.” The authors did not rule out the possibility that the “observed associations merely reflect linkage disequilibrium with other susceptibility genes.”

British Journal of Haematology, 124, 796-801.

BACK TO BASICS – WASHING HANDS TO PREVENT ILLNESS

It is well understood that hospitals are great places to pick up infections. Christine Gorman reported in Time last month that hospital infections contribute to nearly 90,000 deaths in the US each year. This in the face of a number of studies that show hospital staffs generally follow hand-washing guidelines less than 40% of the time. Many suggestions have been offered. Some hygiene experts have suggested that patients ask doctors and nurses whether they have washed their hands. But the question becomes how to do this without putting the caregiver on the defensive? Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, suggests one way “might be to say, ‘I’ve read that it’s important for health care professionals to wash their hands frequently and that doctors are so busy they sometimes forget.’” Say it with a smile.

Christine Gorman, TIME, March 29, 2004, p. 81.

SNAKE BITE CAN CAUSE LOW PLATELETS

A 38 year old male patient experienced a timber rattlesnake bite and went to the emergency room within one hour of the bite. Within three days his platelet count dropped to 590 per cubic millimeter. The patient continued to experience thrombocytopenia despite large quantities of CroFab antivenom. Timber rattlesnake bites commonly cause thrombocytopenia. This case suggests that the established treatment for rattlesnake bite may not be sufficient to correct the venom-induced thrombocytopenia.

EMBRYONIC STEM CELLS: FUTURE APPROACH TO TREATMENT?

Researchers at the Graduate School of Biomedical Sciences, Hiroshima University have demonstrated the development of functional platelets from murine (mouse) embryonic stem cells. They suggest that embryonic stem cell derived platelets could be a substitute for platelet transfusions. They suggest their work “should facilitate functional studies using gene-transferred platelets and be a future approach for treatment of platelet disorders.”

Tetsuro-Takahiro, et. al., Production of Functional Platelets by Differentiated Embryonic Stem (ES) Cells in Vitro, BLOOD, 1 December 2003, volume 102, number 12, pp4044-4051.

NEW TEST TO IDENTIFY MYELODYSPLASTIC SYNDROME (MDS)

Investigators at the Pacific Northwest Research Institute (PNRI) in collaboration with researchers at Johns Hopkins University have developed statistical models that identify patients with MDS, or those at a high risk for the disease. Donald C. Malins, PhD, DSc, director of biochemical oncology at the PNRI, said, “the DNA test for MDS is highly predictive …. and is the first molecular marker capable of distinguishing MDS patients as a group from patients with nonmalignant bone marrow disorders.”

John Watson, Hem/Onc Today, May 2004.

(These new tests are important in the diagnosis of ITP because ITP can be confused with MDS and the treatments for the two diseases are very different. Since ITP is a diagnosis of exclusion, these tests are potentially beneficial for both MDS and ITP patients)

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