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 healthcare professional.
ITP and Platelet Disorders Research and Treatments
- Rituxan: Beware Hepatitis B
- Inherited Bleeding Disorders: Not So Rare
- SSRIs and Bleeding Linked Again
- New Treatment Approach: Gut Bacteria
Hospitals, Insurance, and Medical Care
General Health and Medicine
ITP and Platelet Disorders Research and Treatments
Rituxan.. Beware Hepatitis B
Rituximab (Rituxan®) can reactivate hepatitis B in those who have had the disease. Because of this potential health problem, the package insert now includes a new boxed warning for the treatment. The new package information includes a recommendation for screening all patients for hepatitis B before receiving rituximab as well as suggestions for treating hepatitis B should it occur.
“Arzerra (ofatumumab) and Rituxan (rituximab): Drug Safety Communication - New Boxed Warning, Recommendations to Decrease Risk of Hepatitis B Reactivation.” FDA. Sep 25 2013.
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm369846.htm
Inherited Bleeding Disorders: Not So Rare
Low platelets can be caused by a genetic anomaly, not just antibodies. While each of the individual inherited (genetic) bleeding disorders is rare, in total, they are not. Some of these inherited bleeding disorders, such as Bernard-Soulier Syndrome, have been known for 20 years, but others have been more recently characterized. “[Most] can be diagnosed by a combination of clinic history, physical examination, and standard laboratory studies, including an assortment of platelet morphologic and functional studies. Confirmatory, targeted-gene analyses are often done.”
Lambert MP, Poncz, M. “They're not your Daddy's Inherited Platelet Disorders anymore.” J Thromb Haemost. Sep 14 2013, pp:1538-7836.
http://onlinelibrary.wiley.com/doi/10.1111/jth.12405/abstract
Note: Some people with an inherited bleeding disorder are misdiagnosed as having ITP. PDSA has more information at:
http://www.pdsa.org/about-itp/and-families.html
and
http://www.pdsa.org/resources/other-platelet-disorders.html
SSRIs and Bleeding Linked Again
SSRIs (selective serotonin reuptake inhibitors) are a popular class of drugs used to treat depression. Think Prozac®, Paxil ® and Zoloft ®. In the past, a number of studies have associated the use of these drugs with upper gastrointestinal bleeding after several months use. This new study shows that bleeding can occur much earlier. The study measured bleeding at 7, 14, and 28 days and found bleeding at each timeframe.
Wang YP et al. “Short-Term Use of Serotonin Reuptake Inhibitors and Risk of Upper Gastrointestinal Bleeding.” Am J Psychiatry. Sep 13 2013.
http://ajp.psychiatryonline.org/article.aspx?articleid=1738031
New Treatment Approach: Gut Bacteria
Your gut plays a big part in maintaining a healthy immune system, so an unhealthy gut could cause problems. Now scientists figured out a way to regulate gut immune functions. They manipulated gut bacteria in mice to enhance the activity of specific T-regulatory cells (Tregs), cells that play an important role in the development of autoimmune diseases such as ITP. They conclude: using targeted bacteria to change the gut has potential for treating immune disorders.
Atarashi R. “Treg induction by a rationally selected mixture of Clostridia strains from the human microbiota.” Nature 500. 232–236. Aug 8 2013.
http://www.nature.com/nature/journal/v500/n7461/full/nature12331.html
Hospitals, Insurance, and Medical Care
Read Practice Guidelines Carefully
Physicians often rely on medical practice guidelines for treatment recommendations. However, a close review of two groups of practice guidelines, one for endocrine problems and another for cancer treatment, shows that these guidelines can be flawed. In the endocrine guidelines 34% of the strong recommendations were based on weak evidence. In a review of 169 guidelines on various types of cancer, researchers found they met only 2.75 of the 8 guideline criteria established by the National Institute of Medicine.
Brett AS. “Clinical Practice Guidelines Require Scrutiny for Quality.” Journal Watch. Sep 26 2013.
http://www.jwatch.org/na32275/2013/09/26/clinical-practice-guidelines-require-scrutiny-quality
Note: PDSA has links to various ITP guidelines and other expert commentary at
http://www.pdsa.org/treatments/treatment-resources/treatmentguidelines.html.
PDSA staff participated in the development of the International Consensus Report and witnessed the rigorous development of that document.
Google Wants to Extend Your Life
Google is experimenting with driverless cars, Internet by balloon, and now…ways to keep us young and healthy for a very long time. The search giant has made a major investment in the California Life Co., or Calico. Calico will be headed by Arthur Levinson, chairman of the boards of Apple and Genentech (maker of Rituxan ®). “For Google, nothing is off limits. Even death is on the firing line.”
Guynn J. “Google launches healthcare company Calico to extend life.” LA Times. Sep 18, 2013.
http://www.latimes.com/business/la-fi-google-aging-20130919,0,3691955,full.story
General Health and Medicine
Beware of Tylenol Overdose
Many people with ITP rely on Tylenol or other products containing the main ingredient, acetaminophen, because aspirin or NSAIDs can promote bleeding. For millions of users Tylenol and like products have been safe and effective; but for 1,500 people in the last decade the drugs were instrumental in their death. Acetaminophen In large amounts, especially if combined with alcohol, can damage or even destroy the liver. It is important to use the medication as directed and read the labels of other drugs to be sure they do not contain acetaminophen and, unwittingly, add to the amount taken.
Gerth J, Miller TC. “Use only as Directed.” ProPublica. Sep 20, 2013:
http://www.propublica.org/article/tylenol-mcneil-fda-use-only-as-directed.
You can find more articles in the series at:
http://www.propublica.org/series/overdose
Detox Your Face
Scientists found ten toxic metals in 32 drugstore lipsticks and lip balms and 75% of the lipsticks tested contained lead. European brands may be safer since the European Union bans more than 10,000 potentially toxic ingredients from make-up while the US bans only nine. The Environmental Working Group (http://www.ewg.org/skindeep/) and The Campaign for Safe Cosmetics (http://safecosmetics.org/article.php?list=type&type=33) have much information to help you choose less toxic products.
Snowder T. “4 easy swaps to make your makeup less toxic.” Happy Living. Sep 12 2013.
http://www.ksl.com/index.php?fm=home_page&nid=1010&s_cid=featured-5&title=4-easy-swaps-to-make-your-makeup-less-toxic&sid=26829198
Note: Low platelets have been linked to toxin exposure. See:
http://www.pdsa.org/about-itp/warnings.html
