Platelet E-News: September 28, 2011

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.


ITP and Platelet Disorders Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine


ITP and Platelet Disorders Research and Treatments



Researchers examined the bone marrow of 25 ITP patients before treatment with a thrombopoietic agent and after a median of 1.4 years of treatment. Of the 25, three had no signs of bone marrow fibrosis (scarring), 19 had grade 1 fibrosis, two had grade 2, and one had grade 3. The results of one of the diagnostic tests suggest that the scaring lessons over time. The authors conclude that low grade reticulum fibrosis is seen in most ITP patients taking TPO agents, however, some of the blood test results were puzzling and need additional explanation.

Ghanima W et al. “Fibroproliferative activity in patients with immune thrombocytopenia (ITP) treated with thrombopoietic agents.” Br J Haematol. 2011 Sep 9.[Epub ahead of print]:

See the “European consensus on grading bone marrow fibrosis and assessment of cellularity” for an explanation of bone marrow fibrosis grading:




Researchers at the Asian Institute of Science and Technology in Malaysia report that papaya leaves and pegaga (Centella asiatica) juice can increase the platelet count of people diagnosed with dengue fever, a mosquito-transmitted viral disease affecting many millions and characterized by persistent thrombocytopenia. According to Dr. Kathiresan, study leader, the powder from papaya leaves has substances responsible for the release and/or production of platelets. The initial study, done in mice, comparing papaya leaf to a placebo, demonstrated that the papaya leaf suspension could raise the platelet count. Researchers are now attempting to isolate the active compound in the preparation.

“Doc: Papaya leaves can cure dengue” The Star Online. August 31, 2011:

“Is Juice From Papaya Leaves A Cure For Dengue?” Yahoo News Malaysia. August 29, 2011:

Kathiresan S et al. “Thrombocyte counts in mice after the administration of papaya leaf suspension.” Wiener Klinische Wochenschrift. Volume 121, Supplement 3, 19-22, 2009.:




Researchers examined the spleens removed from 18 people diagnosed with ITP, some who were treated with rituximab (Rituxan) and others who were not. They found people who were treated with rituximab had no B-cells in their blood and reduced B-cells in their spleen, but still didn’t respond to the treatment. The T-regulatory (Treg) cells, a type of white blood cell, were decreased in all ITP spleens examined. The ratio of pro-inflammatory T cells (Th1) to Tregs was increased in those who failed rituximab. This research points to a rituximab response mechanism separate from B-cell depletion.

Audia S et al. “Immunological effects of rituximab on the human spleen in immune thrombocytopenia.” Blood. 2011 Aug 29. [Epub ahead of print]:




From 25% to 75% of people diagnosed with ITP also have antiphospholipid antibodies (ANA), a condition that could possibly lead to unwanted blood clots. For those diagnosed with antiphospholipid antibody syndrome (APS), from 22% to 42% have low platelets. Researchers in France studied 93 patients with ITP and 27 with APS to determine the severity of the clotting problems. Of the ITP patients in their study, 25% had some type of antiphospholipid antibody. During the approximately 36 months this group was followed, two people with ITP developed blood clots in their veins, with no particular association to their ANA levels. The people with APS had mild thrombocytopenia with no symptoms.

Moulis G, et al. [Antiphospholipid antibodies and the risk of thrombosis: A comparative survey between chronic immune thrombocytopenia and primary antiphospholipid syndrome.] Rev Med Interne. 2011 Aug 22 [Article in French]:

Note: According to the “International consensus report on the investigation and management of primary immune thrombocytopenia” testing for antiphospholipid antibodies (including anticardiolipin and lupus anticoagulant) can be potentially useful in the management of ITP:




Hospitals, Insurance, and Medical Care



According to a Medscape education program for physicians, “healthy behaviors should be the first line of therapy and prescribed by healthcare providers for both prevention and treatment.” However, on average, fewer than 50% of patients with problems that could be helped by lifestyle interventions were counseled to change their unhealthy patterns. Physicians cite barriers to lifestyle counseling such as limited office time, lack of skills, insufficient payment, as well as perception of lack of effectiveness, among other things. To help physicians counter these problems, the American Medical Association offers two toolkits and the American Academy of Family Physicians offers another.

AMA: Healthier Life Steps (Includes patient information):

AMA: A Physician's Guide to Personal Health Program:

AAFP:Americans In Motion—Healthy Interventions (AIM-HI):

Lianov, LS. “Lifestyle Medicine: Tools to Promote Lifestyle Medicine” Medscape Internal Medicine Education:
(Note: In order to view this article on this website you will be required to register for a free account)




On August 15, Facebook changed its policy for pages established by drug companies. They no longer give those companies an option to prevent public comments. This policy change prompted various reactions from the drug companies. Some, like Johnson and Johnson and AstraZeneca removed certain Facebook pages. Other companies such as GlaxoSmithKline created prominent notes explaining their deletion policies. Meanwhile, the FDA has not given drug companies any guidance on whether they are obligated to report adverse events posted on Facebook. The FDA is actively working on a policy that will deal with all Internet communications to resolve this legal gray area.

Dolan, PL. “Drugmakers must allow visitor comments on Facebook pages.” American Medical News. August 29, 2011:




General Health and Medicine



Twenty percent of heart attack patients developed moderate to severe anemia in the hospital due to blood tests, not heart disease, report researchers who looked at the records of 17, 676 patients. The risk of hospital-acquired anemia increased 18% for each 50mL of blood drawn and could lead to worse outcomes or even death. Dr. Kosiborod, the study author, suggests several ways to help solve this problem: use pediatric tubes that require less blood, do multiple tests from a single draw, and closely examine whether a particular blood test is needed.

Gardner A. “Many Heart Patients Anemic After Too Many Blood Tests in Hospital’” US News Health. August 8, 2011:

Salisbury AC. “Diagnostic Blood Loss From Phlebotomy and Hospital-Acquired Anemia During Acute Myocardial Infarction.” Arch Intern Med. 2011 Aug 19. [Epub ahead of print]:

Note: A single tube blood draw may contain as much as 10 mL of blood. Some people feel their platelet counts declined after many tubes of blood were drawn.




Researchers calculated the benefit of various amounts of exercise reported on questionnaires from 416,175 people in Taiwan. They found that just 90 minutes of exercise a week, averaging 15 minutes a day, was enough to increase the average lifespan by three years. Each additional 15 minutes of exercise a day reduced mortality by 4% and cancer risk by 1%. This was true for men and women of all ages as well as those at risk for cardiovascular disease.

Wen CP et al. “Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study.” Lancet. 2011 Aug 14. [Epub ahead of print]:





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, e-mail:

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