ITP and Platelet Disorders Research and Treatments
- Thrombopoietin Levels Help Predict TPO Treatment Response
- Rituxan and Vaccines Don’t Mix
- Antiplatelet Antibody Tests Gain Clout
- When Will a Child with ITP Improve?
Hospitals, Insurance, and Medical Care
General Health and Medicine
ITP and Platelet Disorders Research and Treatments
Thrombopoietin Levels Help Predict TPO Treatment Response
Thrombopoietin stimulates the bone marrow to produce more platelets. However, people with ITP often fail to produce higher thrombopoietin levels to compensate, as seen in those with other low platelet diseases. In a new study, researchers looked at the TPO levels of people with various reasons for low platelets, including 21 with ITP who were treated with the TPO receptor agonists, romiplostim or eltrombopag. The study participants with ITP who had TPO levels greater than 95pg/mL did not respond well to the TPO agents. The authors conclude: “Elevated TPO levels in ITP patients may predict a poor clinical response to treatment with TPO receptor agonists.”
Note: A test to measure TPO levels is available through Quest Diagnostics (test no. 16336).
Makar RS et al. “Thrombopoietin (TPO) levels in patients with disorders of platelet production: Diagnostic potential and utility in predicting response to TPO Receptor agonists.” Am J Hematol. 2013 Aug 1.
http://www.ncbi.nlm.nih.gov/pubmed/23913253
Rituxan and Vaccines Don’t Mix
If you received vaccinations within six months of receiving rituximab (Rituxan®), they were probably ineffective. In a new study, people who received pneumonia and flu vaccines six months after their rituximab treatments had a significantly lower response to these vaccines than the placebo group. Nearly 20% did not respond to the vaccines at all. Rituximab depletes B-cells (cells that make antibodies) and also reduces cellular immunity (the part of the immune system that doesn’t include antibodies), both needed for a healthy immune system. This cellular depletion lasts at least six months and has implications for the lack of response to vaccinations and the increased risk of infection seen in rituximab patients.
Nazi I et al. “The effect of rituximab on vaccine responses in patients with immune thrombocytopenia.” Blood. 2013 Jul 12.
http://www.ncbi.nlm.nih.gov/pubmed/23851398
Antiplatelet Antibody Tests Gain Clout
In the past, many doctors did not order antiplatelet antibody tests for people with suspected ITP since these tests could not accurately diagnose the disease. Now researchers have found another potential use for the tests: helping to predict treatment response and the general course of ITP.
In one study, researchers measured antiplatelet antibodies attached to three different regions on the platelets of people with ITP: GPIIb/IIIa, GPIb/IX, and GPIa/II. Those with antibodies to GPIIb/IIIa had a much higher response to IVIg and prednisone than people with the other antibody types or those diagnosed with ITP who had no measurable antibodies.
In another study, scientists tested the antiplatelet antibody levels of those newly diagnosed with ITP using the MAIPA diagnostic test, then followed these patients to see if there was a correlation between antibody levels and their disease prognosis. The scientists concluded: “…indirect MAIPA positivity at disease onset is associated with more severe hemorrhage and predicts a chronic course in adult ITP patients.”
Liu XF et al. “Relationship between the expression of autoantibodies against platelet membrane glycoprotein and therapeutic effect in primary immune thrombocytopenia.” Zhonghua Xue Ye Xue Za Zhi.(Chinese Journal of Hematology) 2013 Jul;34(7):610-3.
http://www.ncbi.nlm.nih.gov/pubmed/23906456
Grimaldi D et al. “Antiplatelet antibodies detected by the MAIPA assay in newly diagnosed immune thrombocytopenia are associated with chronic outcome and higher risk of bleeding.” Ann Hematol. 2013 Aug 4.
http://www.ncbi.nlm.nih.gov/pubmed/23912633
When Will a Child with ITP Improve?
Most children with ITP improve within a year, regardless of treatment, but some go on to have a much longer struggle with low platelets. Knowing whether a child will recover soon could influence treatment choices. The results of two new studies could help.
Study 1: Researchers found two factors in children who recovered more quickly from the disease: age less than 10 and a sudden onset of low platelets.
Study 2: The T-cell profile, some cytokines (cell-signaling molecules), and several blood proteins were not the same in children who had a short course of ITP and those who developed the chronic form. Because of these physical variations, the study authors concluded that chronic ITP in children is a different disease than the acute version.
Revel-Vilk S et al. “Age and Duration of Bleeding Symptoms at Diagnosis Best Predict Resolution of Childhood Immune Thrombocytopenia at 3, 6, and 12 Months.” J Pediatr. 2013 Jul 24.
http://www.ncbi.nlm.nih.gov/pubmed/23891349
Jernås M et al. “Differences in gene expression and cytokine levels between newly diagnosed and chronic pediatric ITP.” Blood. 2013 Jul 18.
http://www.ncbi.nlm.nih.gov/pubmed/23869085
Hospitals, Insurance, and Medical Care
Best Hospital List Published
US News and World Report staff analyzed data for 5,000 hospitals to determine the best and published their results for all to see. You can search their ratings for adult and children’s hospitals in total, by 16 specialty areas (alas, no hematology) and by region. See: Best Hospitals
http://health.usnews.com/best-hospitals
Some Medical Procedures May Be Useless or Worse
Is newer better? Not always, according to a new study. Of the 343 established medical practices listed in the New England Journal of Medicine from 2001 to 2010, 146 of the recommended drugs or procedures were found to be no better and sometimes worse than the previous practices. More than 40% of the usual practices studied were found to be either harmful or ineffective. Dr. Prasad, lead author of the report has this to say to patients when their doctor recommends a medical procedure: “…the real question is: Does it work? What evidence is there that it does what you say it does? What trials show that it actually works? You shouldn’t ask how does it work, but whether it works at all.”
Bakalar N. “Medical Procedures May Be Useless, or Worse.” New York Times. 2013 July 26
http://well.blogs.nytimes.com/2013/07/26/medical-procedures-may-be-useless-or-worse/
Vinay Prasad, MD et al. “A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices.” Mayo Clin Proc. 2013 August;88(8):790-798.
http://download.journals.elsevierhealth.com/pdfs/journals/0025-6196/PIIS0025619613004059.pdf
General Health and Medicine
Exercise Can Change Your Genetics
You are born with a set of genes, but some things within your own control can determine whether these genes and the proteins they signal get turned on or off. Exercise is one of them. In a Swedish study, scientists measured physical changes in a group of previously sedentary men after they completed a six-month exercise program. In addition to the weight loss, lower blood pressure, and lower cholesterol they expected, the researchers found changes in more than 17,900 individual locations on 7,663 separate genes in fat cells that could affect their functioning.
Reynolds G. “How Exercise Changes Fat and Muscle Cells.” New York Times. 2013 July 31.
http://well.blogs.nytimes.com/2013/07/31/how-exercise-changes-fat-and-muscle-cells/
Volkov RT et al. “A six months exercise intervention influences the genome-wide DNA methylation pattern in human adipose tissue.” PLoS Genet. 2013 Jun;9(6).
http://www.ncbi.nlm.nih.gov/pubmed/23825961
Get More Energy – Chew Your Food
A group of students were given almonds and asked to chew them 10, 25, or 40 times. When the amount of fecal fat and energy was calculated, those who chewed the almonds the longest gained the most value and energy from the food. Vegetables, fruits, and whole grains are the best source of energy and when they are chewed well the body will absorb the smaller particles more easily. These high-fiber foods will also result in a greater loss of fat since fiber binds to fatty acids to produce energy.
“The benefit of chewing your food more.” Medical News Today. 2013 Jul 18.
http://www.medicalnewstoday.com/articles/263541.php
