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
- TPO Agents Can Lead to Remission
- Eltrombopag Helps Prepare for Surgery
- Romiplostim Safe and Effective Long Term
- Immune Deficiency Common in ITP
Hospitals, Insurance, and Medical Care
- Report Problems with Medical Products in Children to the FDA
- Choosing Wisely Lists Ninety More Unnecessary Medical Tests
General Health and Medicine
ITP and Platelet Disorders Research and Treatments
TPO Agents Can Lead to Remission
For almost everyone who takes them, the thrombopoietin agents (romiplostim and eltrombopag) promote a safe platelet count as long as they are given. However, for some, the platelet count can remain at a safe level when the treatments are discontinued. In a study of 31 chronic ITP patients taking TPO agents in a single practice, nine were able to discontinue the treatments and retain their elevated platelet count. In three of these patients, the platelets remained above 100,000/µl and didn't return to baseline. This study supports the practice of gradually lowering the dose of these treatments.
Ghadaki B et al. "Sustained remissions of immune thrombocytopenia associated with the use of thrombopoietin receptor agonists." Transfusion. 2013 Mar 3.
http://www.ncbi.nlm.nih.gov/pubmed/23451917
Eltrombopag Helps Prepare for Surgery
Surgical guidelines suggest platelet counts of at least 50 000/µl before minor surgery and 80 000/µl before major surgery. Of the 494 participants in the eltrombopag (Promacta®/Revolad®) studies, 87 had either a major or minor non-dental surgery. Prior to their surgery the majority of these people had platelet counts within the guidelines and only two experienced a bleeding event. These findings show that eltrombopag can raise the platelet count to meet surgical guidelines for most patients.
Tarantino MD et al. "Hemostatic challenges in patients with chronic immune thrombocytopenia treated with eltrombopag." Platelets. 2013 Feb 12.
http://www.ncbi.nlm.nih.gov/pubmed/23402314
Romiplostim Safe and Effective Long Term
Patients taking romiplostim (Nplate®) for up to five years (recorded in a single-arm, open-labeled study) were generally able to maintain a platelet count of 50 000/µl. on stable doses of the treatment. No new side effects were noticed in the group and very few people required rescue therapies. There were few serious adverse events and these didn't increase with the length of time someone was treated
Kuter DJ et al. "Long-term treatment with romiplostim in patients with chronic immune thrombocytopenia: safety and efficacy." Br J Haematol. 2013 Feb 22.
http://www.ncbi.nlm.nih.gov/pubmed/23432528
Immune Deficiency Common in ITP
Researchers looked at the humoral immunity of people with ITP, the part of the immune system present in body fluids, not regulated by cells such as white blood cells. To study humoral immunity they gave volunteers a dose of pneumonia vaccine and measured the antibodies people developed as a result of the shot. Normally, someone would develop antibodies against the types of pneumonia in the vaccine and therefore be less prone to get pneumonia. Of the people in the study, 39% showed signs of some immune deficiency. A specific antibody deficiency was the most common. The authors recommend that people with ITP get an evaluation of their immune function. This is especially important for people who have had a splenectomy since the spleen plays a role in antibody production.
Rahiminejad MS. "Evaluation of humoral immune function in patients with chronic idiopathic thrombocytopenic purpura." Iran J Allergy Asthma Immunol. 2013 Mar;12(1):50-6.
http://www.ncbi.nlm.nih.gov/pubmed/23454778
Hospitals, Insurance, and Medical Care
Report Problems with Medical Products in Children to the FDA
Clinical trials in children are usually very small so it is important to report serious adverse events for drugs and devices used by children to the FDA. When reporting be sure to include the product name, type, dose, how it was used, age of the child, other medications or medical conditions, outcome, contact information for the person submitting the report, and the child's doctor. The FDA places these reports in a database that is monitored by staff to determine if additional follow-up is needed. You can report adverse event problems for children and adults on-line through MedWatch, http://www.fda.gov/Safety/MedWatch/HowToReport/default.htm
FDA Consumer Update. Report Kids' Problems With Medical Products. Feb. 19, 2013.
http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm339672.htm
Choosing Wisely Lists Ninety More Unnecessary Medical Tests
In February, 17 medical societies added 90 more tests and procedures that are often unnecessary and could be harmful to the Choosing Wisely Web site. Choosing Wisely®, a campaign of the American Board of Internal Medicine Foundation, seeks to reduce treatment costs, reduce the risks associated with additional procedures, and change the medical culture of 'more is better." The group hopes information on the Web site will help patients engage in a conversation with their doctors when their situation matches those on the list.
Choosing Wisely: http://www.choosingwisely.org/
General Health and Medicine
Salt Linked to Autoimmune Disease
Salt, sodium chloride, found in processed foods and many home salt shakers, can alter CD4+ helper T-cells (TH17 cells), cells that help regulate the immune system. Researchers in Germany and the US found these altered TH17 cells caused additional inflammation which can lead to autoimmune disease. More salt led to more inflammation and more problems. Some salt is necessary for the body to function. However, pure sodium chloride, salt without accompanying minerals present in sea salt, may be causing more problems because minerals are absent from many people's diets.
Kleinewietfeld M et al. "Sodium chloride drives autoimmune disease by the induction of pathogenic TH17 cells." Nature. 06 March 2013.
http://www.ncbi.nlm.nih.gov/pubmed/23467095
McCarthy A. "Scientists Officially Link Processed Foods To Autoimmune Disease." PreventDisease.com. 07 March 2013.
http://preventdisease.com/news/13/030713_Scientists-Officially-Link-Processed-Foods-To-Autoimmune-Disease.shtml
Common Drugs Can Cause Thrombocytopenia
Millions of people take drugs to lower their blood pressure and cholesterol. These drugs, taken individually or in combination, may trigger low platelets for someone susceptible to drug-induced thrombocytopenia. In a case report, doctors found that a low blood pressure medication, amlodipine (a calcium channel blocker with many different names) definitely caused their patient's low platelets and the cholesterol-lowering drug, simvastatin (Zocor) probably contributed to the low platelets as well. This case reminds us that some of the most popular drugs can cause low platelets and it is difficult to determine the specific drug culprit when someone is taking more than one drug.
For more information on drug-induced thrombocytopenia and a list of drugs that are known to cause low platelets see:
http://www.ouhsc.edu/platelets/ditp.html
Cvetković Z, et al. "Simvastatin and amlodipine induced thrombocytopenia in the same patient: double trouble and a literature review."J Clin Pharm Ther. 2013 Feb 26
http://www.ncbi.nlm.nih.gov/pubmed/23442182
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
