Platelet E-News: November 27, 2013

ITP and Platelet Disorders Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine


ITP and Platelet Disorders Research and Treatments

ListLong-term Nplate® side effects tallied

Researchers summarized the side effects for 653 patients with ITP enrolled in 13 romiplostim (Nplate®) clinical trials. The patients were treated for up to 5 years, 921.5 patient-years total. Results: 6% had thrombotic, blood clotting, events (some linked to a larger than recommended dose or count); 8% had serious bleeding; 1.8% developed bone marrow reticulum; 3.8% died. The authors conclude: “Our data demonstrate that long-term romiplostim treatment is well tolerated, with no new safety signals, even in patients treated for up to 5 yr.”

Rodeghiero F et al. “Long-term safety and tolerability of romiplostim in patients with primary immune thrombocytopenia: a pooled analysis of 13 clinical trials.” European Journal of Hematology. 91.5: 423–436, Nov 2013.


For Lupus Related ITP Consider Plaquenil®

Hydroxychloroquine (Plaquenil, Axemal, Dolquine, Quensyl) is sometimes used to treat lupus, rheumatoid arthritis, and other diseases. However, it is not a treatment used for ITP. In this new report doctors gave hydroxychloroquine to12 patients diagnosed with both ITP and lupus and another 28 patients diagnosed with ITP who also had a high ANA test result (one marker for lupus). Overall, 60% of people in the study responded to the treatment. Those who were officially diagnosed with both diseases had a higher response rate.

Khellaf M et al. “Hydroxychloroquine is a good second-line treatment for adults with immune thrombocytopenia and positive antinuclear antibodies.” Am. J. Hematol. Oct 28 2013.


Sterol Storage Disorder Confused with ITP

Another genetic disease has been confused with ITP, sitosterolemia (phytosterolemia). All 13 patients with this disease in the study had been misdiagnosed as having ITP, one person for 28 years. Patients with sitosterolemia can have low red cells, abnormally large platelets, premature arteriosclerosis, red or orange fatty bumps on the skin, and more. This article reminds us that ITP is a diagnosis of exclusion and sometimes other causes of low platelets are missed. It is important to tell your doctor about all medical problems to help get an accurate diagnosis.

Note: For more information on genetic causes of low platelets see:

Wang Z et al. “Specific macrothrombocytopenia/hemolytic anemia associated with sitosterolemia.” Am. J. Hematol. Oct 26 2013.


T-cells May Hold Key to Predicting Rituxan ® Success

Wouldn’t it be wonderful if there was a test to determine if you are going to respond or not to a treatment, rather than the current trial-and-error treatment model? Researchers are making some progress toward this goal. A group of scientists in France and the US found a difference in the spleen cells between those who responded to rituximab (Rituxan®) and those who didn’t. Those who didn’t respond had an increase in CD8+ T-cells and these CD8+ T-cells were in a specific pattern.

Audia S et al. “Preferential splenic CD8+ T-cell activation in rituximab-nonresponder patients with immune thrombocytopenia.” Blood. Oct 3 2013.


Hospitals, Insurance, and Medical Care

Third Leading Cause of Death in US Hospitals – Medical Errors

Many more people are dying in US hospitals from medical mistakes than previously reported, perhaps more than four times more. This makes medical errors the third leading cause of death behind heart disease and cancer. Since no one counts all medical errors and sometimes these are not reported, all numbers are estimates. However, no matter what the number, the research shows a problem that needs to be addressed. Patients can help by reporting harmful events and participating in follow-up investigations.

Allen M, ProPublica. “How Many Die from Medical Mistakes in U.S. Hospitals?” Scientific American. Sep 20 2013

Rodak S. “Study: Medical Error Deaths 4.5 Times More Likely Than IOM Estimate.” Becker’s Clinical Quality and Infection Control. Sep 20 2013.

James JT. “A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care.” Journal of Patient Safety. Sep 2013 9.13:122–8.,_Evidence_based_Estimate_of_Patient_Harms.2.aspx


RX CasePrescription-Drug Imports Approved in Maine

It is no secret that people outside of the US pay less for their pharmaceuticals. Saving money by using foreign pharmacies is nothing new to those near the Canadian border. The city of Portland, Maine, saved more than $3.2 M by using a Canadian drug service between 2004 and 2012. Recently, the state of Maine has passed a law, the first of its kind, sanctioning the use of foreign pharmacies for the purchase of drugs. The drug makers are suing the state citing safety concerns.

Levitz J, Martin TW. “Maine to Allow Prescription-Drug Imports.” Wall Street Journal. Oct. 11 2013.


General Health and Medicine

Diet Linked to Depression and Inflammation

Many people with ITP are depressed from the disease and the treatments, but their depression can be difficult to manage since drugs like Prozac can impact platelets. Diet changes could help. In one study, more than 43,000 women who were not depressed were followed for 12 years. Those who consumed soft drinks, fatty red meat, and refined grains (ex. pasta, white bread, crackers) consistently were about 40% more likely to be diagnosed or treated for depression over time than the healthier eaters. The depressed women also had elevated markers for inflammation. A Mediterranean diet high in vegetables, olive oil, and fish was linked to a lower rate of depression in prior studies. Diet choices can also reduce inflammation.

Note: Inflammation has been linked to ITP. For information on diet and ITP see:

Heid M. “Pass the pasta -- and the Prozac?” Prevention News. Oct 2013.


AcupunctureAcupuncture Comes to the Rescue

Acupuncture and counseling may also improve depression according to a new study. In this study 755 people with long-standing, moderately-severe depression were divided into three groups. One group received the standard treatment for depression; a second group got the standard treatment plus acupuncture, and the third group had the standard treatment plus humanistic counseling. Both the acupuncture and counseling groups fared better than the standard treatment group. “Acupuncture seems like an excellent second-line, and perhaps even first-line, treatment for primary-care patients preferring an alternative therapy.”

Note: People with low platelets can safely get acupuncture treatments according to experts. See:

Roy-Bryne P. “Acupuncture for Depression Really Works!” NEJM Journal Watch. Oct 11 2013.

MacPherson H. “Acupuncture and Counselling for Depression in Primary Care: A Randomised Controlled Trial.” PLOS Medicine. Sep 24,2013.



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