Successful Treatment of Immune
Thrombocytopenia with Ascorbic Acid

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Immunohematology, 1988

A. Brox, K. Howson-Jan, A.A. Fauser, Division of Hematology, Department of Medicine. Royal Victoria Hospital and McGill University, Montreal, Canada.

ABSTRACT

Several Options are available in the treatment of ITP in patients who fail corticosteroids (CS). Other treatment fidelities such as, splenectomy (SP), danazol (D), vinca alkaloids (VA), azathioprine (AZA), colchicine (COL), and immunoglobulin (IG) have significant adverse effects. We have treated a series of 8 patients with oral ascorbic acid. 2 grams once daily "Before breakfast 4/500mg tablets) Consume a liter of liquid during the day 64 oz. or more.

The medium duration to achieve maximum platelet count was 10 weeks (range 2-15 weeks). Platelet survival studies demonstrated prolongation of the half-life to 1-2.5 days in 3 patients studied. Megakaryocytic colony formation (CFU-M) has been assessed in patients receiving ascorbate. The number of megakaryocyte colonies increased three fold when bone marrow was plated with autologous plasma as compared to control plasma. No patient has developed evidence of a myaloproliferative disorder as evidenced by normal exam, CBC, biochemistry or cytopenetios. Univariate analysis showed correlation of response with prior splenectomy and initial low platelet count. No other factors where identified using multivariate analysis. All patients have maintained their platelet count while on ascorbate. Ascobiac acid appears to be benefit in ITP. Although its exact role in treatment awaits definition, its safety and cost make it an attractive alternative.

Other Vitamin C Abstracts from Medline

[1] Pilot study of ascorbic acid for the treatment of refractory immune thrombocytopenic purpura. Author Jubelirer SJ Address Cancer Care Center, Southern West Virginia Charleston Area Medical Center. Source Am J Hematol, 43(1):44-6 1993 May

Abstract

The treatment of corticosteroid- and/or splenectomy-refractory immune thrombocytopenic purpura (ITP) includes vinca alkaloids, immunosuppressives, Danazol, intravenous gammaglobulin, and alpha-interferon. However, these treatments have often been associated with toxic side effects. Brox et al. (Br J Haematol 70:341-344, 1988) reported the efficacy of ascorbic acid in the treatment of ITP; the platelet count normalized in seven of 11 patients studied, and tolerance was excellent. However, other investigators have reported less impressive results. These conflicting reports prompted a pilot study of ascorbic acid in 12 patients with refractory ITP. Patients were given 2 g every morning for at least 10 weeks. All have received glucocorticoids, three had undergone splenectomy, and six received other treatments. The maximal increase in platelet count above baseline (i.e., the prestudy platelet count) achieved was < 20,000 in 11 patients and 25,000 in one patient. Therapy was well tolerated, with only two patients complaining of dyspepsia. The results of this study suggest that ascorbic acid is not very effective in patients with refractory ITP.

[2] Results of the treatment of chronic idiopathic thrombocytopenic purpura with ascorbic acid Author Karduss Urueta A; Morales Polanco MR; Pizzuto Chávez J; Meillón García LA Address Servicio de Hematología, Hospital de Especialidades CMN Siglo XXI, IMSS, México D.F. Source Gac Med Mex, 129(1):23-5 1993 Jan-Feb

Abstract

The main objective of the present work is to describe the results of the treatment with ascorbic acid in thirteen patients with refractory chronic idiopathic thrombocytopenic purpura (CITP) and to compare its results with those informed in the literature. The patients received ascorbic acid 2 g/day, orally, in the morning during at least eight weeks. At the end of the period of control there were only four partial responses (30%); the remaining patients did not experience any kind of favorable reaction. Previous publications informed mean partial and complete responses of 11 and 19% respectively. According to such results and those of the present work, and taking into account the generally transitory duration of the response it is concluded that ascorbic acid is of no use in the treatment of CITP.

[3] Ascorbic acid for the treatment of chronic refractory idiopathic thrombocytopenic purpura (ITP). Author Vianelli N; Gugliotta L; Gianni L; Belmonte MM; Catani L; Tura S Address Istituto di Ematologia L. e A. Seràgnoli, Università degli Studi di Bologna, Italy. Source Haematologica, 77(1):92-3 1992 Jan-Feb

Abstract

We describe our experience with ascorbic acid in the treatment of chronic refractory ITP. Nine patients, 5 males and 4 females aged 27-74 years, 4 of whom were previously splenectomized, received the drug at a daily dose of 2 grams. After 2-12 months (median 4) of treatment, a partial response was observed in only one patient, while no response was registered in the other eight. Our data, analyzed together with those of the literature, allow us to conclude that ascorbic acid may not be considered a drug of interest in the treatment of chronic refractory ITP.

[4] Chronic ITP with a remarkable response to vitamin C administration after splenectomy Author Nomura S; Yanabu M; Soga T; Fukuroi T; Kido H; Nagata H; Kokawa T; Yasunaga K Address First Department of Internal Medicine, Kansai Medical University. Source Rinsho Ketsueki, 31(4):523-4 1990 Apr

Abstract

This report deals with a case of 23-year-old woman with chronic idiopathic thrombocytopenic purpura (ITP) showing a favorable response to vitamin C (VC) administration. She was treated with glucocorticoids and immunosuppressants, whereas inadequately controlled with its tolerable dosage. Next, she underwent splenectomy. However, there were only transient effects on platelet counts, so the therapy with ascorbate was carried out according to the report by Brox et al. The platelet counts increased to 20 x 10(4)/microliters after 4 months. Side effects of VC therapy did not occur.

[5] Treatment of idiopathic thrombocytopenic purpura with ascorbate [see comments]

Author Brox AG; Howson-Jan K; Fauser AA Address Department of Medicine, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada. Source Br J Haematol, 70(3):341-4 1988 Nov

Abstract

The treatment of idiopathic thrombocytopenic purpura (ITP) includes corticosteroids, danazol, splenectomy and various immunosuppressives. Treatment can be difficult for those patients refractory to these modalities and/or those patients intolerant of the secondary effects. In this paper we report on the use of ascorbate in the treatment of ITP and its successful use in seven of 11 patients studied. We found that therapy with ascorbate appeared to improve the platelet count and the intravascular survival of platelets. Because of excellent patient compliance and its lack of toxicity, it may be an alternative for the treatment of ITP. The exact role of ascorbate in the treatment of ITP, as well as its mechanism of action, await further study.

(Thanks to Tim for this research)