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.

Contents:

ITP and Platelet Disorders Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine

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ITP and Platelet Disorders Research and Treatments

 

CAN WE BLAME ITP ON THE ENVIRONMENT?

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.
http://www.niehs.nih.gov/news/newsletter/2012/9/science-autoimmune/index.htm

ITP UPDATE: NEW ARTICLE PRESENTS CONCISE DISEASE SUMMARY

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:
http://www.ccjm.org/content/79/9/641.full.pdf+html

SYMPHOGEN PUBLISHES PHASE II TRIAL RESULTS FOR POTENTIAL ITP TREATMENT

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]
http://www.ncbi.nlm.nih.gov/pubmed/22915649

For more information about anti-D treatments see:
http://www.pdsa.org/treatments/conventional/anti-d.html

ROMIPLOSTIM PLUS IVIG – AN EFFECTIVE COMBINATION

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.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2141.2012.09220.x/pdf

 

Hospitals, Insurance, and Medical Care

US LAGS IN DEALING WITH PREVENTABLE DEATHS

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.
http://www.ncbi.nlm.nih.gov/pubmed/22933419

BEWARE OF TAINTED PLATELETS

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.
http://online.wsj.com/article/SB10000872396390444226904577559332064269396.html

Landro L. "Cutting the Risk of Tainted Platelets." Wall Street Journal. July 31, 2012.
http://blogs.wsj.com/health/2012/07/31/cutting-the-risk-of-tainted-platelets/

 

General Health and Medicine

CDC: CHECK YOUR HEPATITIS C LEVELS

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.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6104a1.htm

WANT TO LIVE LONGER? HERE'S HOW

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:
http://www.pdsa.org/treatments/complementary.html

Rizzuto D et al. "Lifestyle, social factors, and survival after age 75: population based study." BMJ. 2012 Aug 29;345:e5568:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3431442/

 

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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: http://www.pdsa.org, e-mail: pdsa@pdsa.org

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