Platelet E-News – July 22, 2009

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 health care professional.

Contents:

ITP Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine

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General Health and Medicine

DIVERSITY OF ITP SUGGESTS THAT PRIMARY AND SECONDARY ITP ARE AUTOIMMUNE SYNDROMES
Patients and hematologists understand that treatments have a varied effect and there is currently no way to predict which treatment will help any particular individual. A recent 10-page article in the journal Blood summarizes hundreds of research articles that deal with the diversity of ITP and what is known about the changes in antibody production that can prompt low platelets. ITP is a diverse disease, sometimes associated with other infections such as hepatitis C, other autoimmune diseases like lupus, or immune deficiency. The antibody production that characterizes ITP can arise from abnormalities in the bone marrow, as antibodies are produced, or as antibodies are at work in the body. Knowing more about the range of the disease and the action of antibodies can take some of the guesswork out of treating ITP.

Cines DB, Bussel JB, Liebman HA, Luning Prak ET. ”The ITP syndrome: pathogenic and clinical diversity. Blood.” 2009 Jun 25; 113(26):6511-21

http://www.ncbi.nlm.nih.gov/pubmed/19395674

http://bloodjournal.hematologylibrary.org/cgi/reprint/113/26/6511 (entire article)

KILLING STOMACH BACTERIA H. PYLORI IMPROVES THROMBOCYTOPENIA IN SOME PATIENTS WITH ITP
The eradication of H. pylori, a bacteria associated with stomach ulcers, has improved the platelet count of some infected patients diagnosed with ITP. Researchers at McMaster University and Michael G DeGroote School of Medicine reviewed 11 studies (8 from Japan) that compared the success of the H. pylori antibiotic treatment regimen for those ITP patients affected with H. pylori versus those who did not test positive for the bacteria. The researchers concluded that the “odds of achieving a platelet count response following eradication therapy were 14.5 percent higher in patients with H. pylori infection.”

Arnold DM, Bernotas A, Nazi I, Stasi R, Kuwana M, Liu Y, Kelton JG, Crowther MA. “Platelet count response to H. pylori treatment in patients with immune thrombocytopenic purpura with and without H. pylori infection: a systematic review.” Haematologica. 2009 Jun; 94(6):759-62.

http://www.ncbi.nlm.nih.gov/pubmed/19483158

PATIENTS WITH CYCLIC THROMBOCYTOPENIA (CTP) TREATED SUCCESSFULLY WITH NPLATE (ROMIPLOSTIM)
Platelet counts that go up and down in a pattern, such as every 20 to 40 days, called cyclic thrombocytopenia (CTP), do not respond well to the usual treatments for ITP. After failing multiple therapies, two patients with this rare form of thrombocytopenia were treated with romiplostim (Nplate) and have been doing well for several years. Both patients were first diagnosed with ITP and then were subsequently diagnosed with cyclic thrombocytopenia.

Bose P, Hussein KK, Terrell DR, Berger D, Rice L, George JN. “Successful treatment of cyclic thrombocytopenia with thrombopoietin-mimetic agents: a report of two patients.” Am J Hematol. 2009 Jul; 84(7):459-61.

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Hospitals, Insurance, and Medical Care

FDA SETTING NEW LIMITS ON ACETAMINOPHEN AND URGES CONSUMERS TO BE ALERT TO PREVENT OVERDOSE
To help reduce the incidence of liver damage, an FDA advisory panel recommended lowering the recommended daily dose of acetaminophen (in medications such as Tylenol and NyQuil) and banning, or at least severely restricting, Vicodin, Percocet and other prescription drugs that combine acetaminophen with narcotics. The panel is recommending lowering the maximum daily dose from the current 4,000 mg to 2,600 mg. Since acetaminophen is an ingredient in more than 300 over-the-counter and prescription medications, patients must be careful to stay within the recommended dose to avoid liver complications. While the FDA is not bound to follow the advice of advisory panels, they often do so.

M. Beck, “Taking Pains with a Painkiller”, Wall Street Journal, D1, July, 7, 2009

“FDA advisers vote to take Vicodin, Percocet off market”
http://www.cnn.com/2009/HEALTH/06/30/acetaminophen.fda.hearing/index.html

RED YEAST RICE SUCCESSFUL TREATMENT OPTION FOR LOWERING BAD CHOLESTEROL
Red Yeast Rice, a dietary supplement, significantly reduces LDL cholesterol and may be an option for those who cannot tolerate statins, conclude researchers from results of a randomized, placebo controlled study. In addition to taking the supplement or placebo pill, all study patients participated in a 12-week lifestyle program that included nutrition, exercise, and relaxation techniques. LDL cholesterol fell by more than 20 percent in the group taking Red Yeast Rice compared to less than 10 percent in the placebo group. HDL, triglycerides, and liver enzymes were not affected.

(Note: Statins can induce thrombocytopenia in some patients)

Becker DJ, Gordon RY, Halbert SC, French B, Morris PB, Rader DJ. “Red yeast rice for dyslipidemia in statin-intolerant patients: a randomized trial” Ann Intern Med. 2009 Jun 16;150(12): 830-9, W147-9.

http://www.ncbi.nlm.nih.gov/pubmed/19528562

“Red Yeast Rice – Treatment Option for Patients Who Can’t Tolerate Statins” Physician’s First Watch, June 16, 2009

CONSUMERS CAN NOW FIND INFORMATION ON THE CONNECTION BETWEEN THE ENVIRONMENT AND ILLNESS WITH THE CDC'S NEW TRACKING SYSTEM
There is a clear association between the environment and health and now with the CDC’s new Environmental Public Health Tracking Network the effect of the environment on illness will be easier to determine. Prior to the new initiative environmental and health data were maintained in separate locations and were cumbersome to put together to determine causes and patterns. Linking the data has already led to 73 public health actions such as uncovering the relationship between mold and asthma in Massachusetts schools. The CDC will continue to add more data and expand the tracking network to all 50 states.

Visit Tracking Network at www.cdc.gov/ephtracking or watch:

http://www.youtube.com/user/CDCStreamingHealth.

http://www.cdc.gov/media/pressrel/2009/r090707.htm

ACID-SUPPRESSOR MEDICATIONS INCREASE RISK FOR HOSPTIAL-ACQUIRED PNEUMONIA
Patients who took proton pump inhibitors, a type of acid-suppressive medication, (ex. Prilosec, Nexium) were much more likely to acquire pneumonia in the hospital than others concluded researchers who examined 63,878 medical records from 2004 through 2007 at a large urban medical center in Boston. Of all the patients, 52 percent received some form of acid-reduction medication. Nearly 5 percent of the patients who were given this type of medication acquired pneumonia in the hospital compared to 2 percent of the other patients. In a subsequent analysis researchers found that only proton pump inhibitors increased the pneumonia risk.

Herzig SJ, Howell MD, Ngo LH, Marcantonio ER. “Acid-suppressive medication use and the risk for hospital-acquired pneumonia” JAMA. 2009 May 27; 301(20):2120-8

http://www.ncbi.nlm.nih.gov/pubmed/19470989

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General Health and Medicine

INJURIES AND INFECTION FROM PET BITES REQUIRE CAREFUL MEDICAL MANAGEMENT
Bacteria transmitted to humans by bites from cats and dogs can trigger severe infections that require special care and specific antibiotics report researchers in Lancet Infectious Diseases. Pasteurella, Streptococcus, Fusobacterium, and Capnocytophaga, and Staphylococcus aureus (MRSA) are among the types of bacteria present in animal bite wounds. MRSA requires particular attention since it can be shared between animal and human and is sometimes resistant to antibiotics.

Splenectomized patients need to take special care. “Other [than Pasteurella] fastidious gram-negative organisms that have been associated with dog and cat bites include Capnocytophaga canimorsus and Capnocytophaga cynodegmi, especially in patients who had undergone previous splenectomy”

http://emedicine.medscape.com/article/224920-treatment

Richard L Oehler MD, Ana P Velez MD, Michelle Mizrachi MD, Jorge Lamarche MD, Sandra Gompf MD, “Bite-related and septic syndromes caused by cats and dogs” The Lancet Infectious Diseases, Volume 9, Issue 7, Pages 439 - 447, July 2009

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(09)70110-0/abstract

FIRST LARGE-SCALE NATIONAL STUDY ON EFFECTS OF VITAMIN D AND FISH OIL ON PREVENTING DISEASE BEGINS NEXT YEAR
A large-scale, 5-year national clinical trial of 20,000 healthy older people, including 5,000 African Americans, will examine whether vitamin D and fish oil supplements are helpful in protecting against cancer and cardiovascular disease. In this NIH funded study that begins next year, participants will be divided into four groups to provide information about the benefits and risks of moderate to high doses of the supplements.

http://www.worldhealth.net/news/first_large-scale_trial_to_study_effects

FRUCTOSE-SWEETENED BEVERAGES INCREASE ABDOMINAL FAT AND INSULIN RESISTANCE
Overweight study participants who consumed beverages sweetened with fructose added more abdominal fat, became more sensitive to insulin, and increased their cholesterol compared to those who consumed beverages sweetened with glucose. During the 10-week study, all participants consumed 25% of their caloric intake from sugared beverages and all gained weight.

Stanhope KL, Schwarz JM, Keim NL, Griffen SC, Bremer AA, Graham JL, Hatcher B, Cox CL, Dyachenko A, Zhang W, McGahan JP, Seibert A, Krauss RM, Chiu S, Schaefer EJ, Ai M, Otokozawa S, Nakajima K, Nakano T, Beysen C, Hellerstein MK, Berglund L, Havel PJ. “Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans.” J Clin Invest. 2009 May;119 (5):1322-34

http://www.ncbi.nlm.nih.gov/pubmed/19381015

MANY REASONS TO GET MORE VITAMIN B12
According to the latest research vitamin B12 can help maintain a healthy brain, deter depression, build bones, curb cancer, reduce risk of age-related macular degeneration, halt hearing loss, and alleviate anemia. Vitamin B12 is most prevalent in meat, fish, and dairy products. The ability to absorb vitamin B12 usually decreases with age so it is especially important for older folks to make sure they get enough of this vitamin. Also, people who take acid suppressor medications increase their risk from impaired B12 absorption. It’s best to have your doctor check your B12 levels if you are over 50, vegan, or using acid suppressing medication.

“7 Reasons to Aim for More Vitamin B12 Than You’re Probably Getting Now.” Environmental Nutrition, May 2009, Vol. 32, No. 5

ENVIRONMENTAL WORKING GROUP OFFERS 2009 SUNSCREEN GUIDE
According to the Environmental Working Group, “3 of 5 brand-name sunscreens either don’t protect skin from sun damage or contain hazardous chemicals.” To find out if you are using a brand that will work and not harm check the Web site:

http://www.ewg.org/cosmetics/report/sunscreen09

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This e-newsletter is published by the Platelet Disorder Support Association, 133 Rollins Avenue, Suite 5, Rockville, MD 20852, phone 1-87-Platelet, fax: 301-770-6638, web: http://www.pdsa.org, e-mail: pdsa@pdsa.org

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