PDSA E-News: June 27, 2016




Diagnostic Approach May Help Distinguish Inherited Thrombocytopenia from Chronic ITP in Adults

doctorTurns out not everyone diagnosed with ITP has ITP. Inherited thrombocytopenia (low platelets) is a varied group of rare diseases that are often confused with immune thrombocytopenia (ITP). In this study of 23 patients with inherited thrombocytopenia (IT) and nine patients with chronic ITP, researchers developed several criteria to make the distinction between people with low platelets from ITP and those who have inherited thrombocytopenia. They found having any three of the following criteria could signal a patient has an inherited disease:

  • Discovery of low platelets before age 34
  • Family history of low platelets
  • Personal history of bleeding
  • A Mean Platelet Volume (MPV) higher than normal
  • Many large platelets (macrothrombocytes) on the blood smear
  • More than 44% of very large platelets when examined with an electron microscope

If at least three criteria were combined, it was possible to distinguish IT from chronic ITP with 91.3% sensitivity. The authors concluded their diagnostic approach could help to correctly distinguish inherited thrombocytopenia (IT) from chronic ITP, particularly in the context of large platelets.

Fiore M, Pillois X, Lorrain S, et al. “A diagnostic approach that may help to discriminate inherited thrombocytopenia from chronic immune thrombocytopenia in adult patients.” Platelets. 2016 Mar 30:1-8. [Epub ahead of print]


Splenectomy? Read this first! Consider Rituximab First as an Alternative

RituximabSplenectomy remains the preferred treatment for chronic immune thrombocytopenia (ITP) after corticosteroid failure (e.g., prednisone), despite the risks of surgical complications and infections. But that practice may be fading. In this study, researchers suggest Rituxan® (rituximab) should be considered before splenectomy, especially in those people who had not failed more treatments.

The study’s objective was to review and analyze 35 refractory / relapsing cases in ITP patients treated between 2004 and 2013. Rituximab was given for 4 weeks at a standard dosage of 375 mg/m2 . Median age of the patients was 46 years old. The ages ranged from 14 to 80 years old. Overall response rates at 1 and 2 years after the first infusion was 47% and 38% respectively. Complete response rates were 24% and 25% respectively.

Thirty-seven percent of patients maintained a durable response rate for more than a year. A rather dramatic finding was that a durable response after rituximab was more frequently observed in patients undergoing second-line therapy with rituximab (83%) than those in third-line or later therapies (35%). The researchers concluded that rituximab should be considered as an alternative treatment to splenectomy. Rituximab’s efficacy and safety profile should lead us to choose this medical option therapy before splenectomy for ITP patients.

Reboursiere E, Fouques H, Maigne G, et al. “Rituximab salvage therapy in adults with immune thrombocytopenia: retrospective study on efficacy and safety profiles,” Int. J Hematology 2016 Apr 4. [Epub ahead of print] ncbi.nlm.nih.gov, by Reboursiere E, et al.




New Trigger Tool Minimizes Adverse Events in Pediatric Medical Care

Pediatrician with patientA new protocol has been developed by the Agency for Healthcare Research and Quality (AHRQ) that uses patient data to minimize adverse events and catch clinical errors in care at children’s hospitals. The Global Assessment of Pediatric Patient Safety, or GAPPS tool, will assist in developing reduced-risk practices concerning potential safety concerns by alerting physicians about medical “triggers” that could potentially be present based upon past patient experiences and the child’s medical record.

“Trigger tools,” such as GAPPS, are used to scan for adverse and unexpected events after they have occurred; the GAPPS tool is innovative in that it notifies health practitioners of potential issues that could arise over the course of treatment. It prompts the use of alternative methods of therapy to circumvent the issue. For example, “if a health record shows a patient on insulin developed low blood sugar, the tool would prompt a nurse or other safety health care worker to follow up to determine if the hospital failed to give the patient correct insulin dosages. Going forward, hospitals would learn from this assessment how to effectively and appropriately track patients’ insulin dosages and examine trends in how many and what kind of adverse events are occurring.”

This groundbreaking GAPPS tool is especially impressive, considering the common method of adverse event reporting is simply based on the practitioner noting the occurrence of an adverse event. This might not necessarily be translated into a widely-disseminated, traceable, and identifiable piece of data of which other physicians should be alerted. Ultimately, the GAPPS tool will vastly improve patient care in hospitals, and result in far safer practices conducted by physicians to ensure minimization of harm caused by medical care.

Agency for Healthcare Research and Quality. “New Tool Identifies Harms Due to Hospital Care Among Children.” U.S. Department of Health and Human Services. 5/24/2016.




Prioritizing Sleep for a Healthier You

sleeping personIn our busy lives sometimes sleep is our last priority. You know you’re supposed to get at least seven hours of sleep to feel energized the following day, but did you realize that benefits of sleep extend far beyond 24 hours? Between boosting your immune system, helping you slim down, and increasing your overall mental health and wellbeing, the benefits of proper sleep are vital for proper physical functioning.

Adequate sleep can improve your physical health, reducing the frequency of colds and migraines. A study published in the American Medical Association Journal discovered that those who sleep fewer than five hours per night suffered from more infections. Additionally, sleep deprivation, fatigue, and stress were identified as substantial triggers for migraines; unsurprisingly, increased sleep was found to be a correlate for a decrease in migraine frequency.

Adequate sleep can have powerful consequences for weight loss and physical functioning as well. Hormone levels that control hunger and satiety are disrupted without proper sleep; those who are sleep-deprived tend to feel hungry more often, choose higher-calorie foods over healthier options to satisfy their cravings, and have a slower metabolic rate. In addition, sleep can inhibit insulin from maintaining a healthy level of blood sugar, thus stimulating pre-diabetic conditions. Both of these “side-effects” of sleep-deprivation contribute to weight gain and a significant probability of obesity. Conversely, regular exercise can result in a better night’s sleep, and better sleep can lead to easier, longer, and more intense workouts with less recovery time.

To reap these benefits, attempt to establish a more strict bedtime routine and schedule, decrease your overall caffeine intake, restrict alcohol consumption, and power off electronics at least an hour before bed.

Johnson, Melinda, MS, RDN. “6 Surprising benefits of Getting Enough Sleep” U.S. News and World Report: Health. 4/21/2016.



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