Platelet E-News: January 26, 2012

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



Environmental factors such as chemicals, ultraviolet radiation, and even stress or cigarette smoke can alter gene activity and cell function, including changes to immune cells. These genetic changes can lead to the development of autoimmune diseases. In their Discovery Medicine article, available to everyone, researchers from Spain thoroughly document what is known about these environmental triggers and the way certain genes are altered following exposure (epigenetics). There is much more to be learned. There are about 80 autoimmune diseases (including ITP), affecting 5% of the world’s population, with a concentration in developed nations, making epigenetics a very important field of interest that could change the way autoimmune diseases are viewed and treated.

Javierre BM. “Environmental Triggers and Epigenetic Deregulation in Autoimmune Disease.” Discovery Medicine. Volume 12, Number 67, December 2011, p. 535:


Prior research studies point to the link between MMR vaccinations and the development of ITP in a small percent of children, but little is known about the effect on platelets of other childhood vaccinations. To find out more, researchers in Colorado reviewed the records of 1.8 million children in five managed care organizations and confirmed 197 cases of ITP. They then tried to determine if any of these cases followed vaccinations. In the 5 to19 month age group, the only vaccination they found that triggered ITP was the MMR. However, in those children over seven, researchers found an association between hepatitis A, varicella, and tetanus-diphtheria-acellular pertussis vaccines and ITP in a few cases.

O'Leary ST, et al. “The Risk of Immune Thrombocytopenic Purpura After Vaccination in Children and Adolescents.” Pediatrics. 2012 Jan 9:

“Most toddler vaccines not linked to blood disease.” Reuters/Fox News. January 11, 2012:

For more information on vaccines and health see The National Vaccine Information Center:


Some people diagnosed with ITP have recovered when their H. pylori infection was eradicated, so testing for the bacteria and eliminating it, if present, can lead to a remission. In a clinical trial of 270 patients comparing two treatment approaches, the four-drug LOAD combination (levofloxacin, omeprazole, nitazoxanide, and doxycycline) was more effective in eradicating H.pylori than the LAC combo (lansoprazole, amoxicillin, and clarithromycin). The trial participants received 7 or 10 days of the LOAD therapy or 10 days of the LAC treatment. Both the 7 and 10 day regimens of the LOAD treatment were more effective in eradicating the organism than the LAC therapy.

Note: “The detection of H pylori infection, preferably with the urea breath test or the stool antigen test, should be considered in the work-up of adults with typical ITP where it may have clinical impact” states “The International Consensus International consensus report on the investigation and management of primary immune thrombocytopenia.”:

Basu PP et al. “A Randomized Study Comparing Levofloxacin, Omeprazole, Nitazoxanide, and Doxycycline versus Triple Therapy for the Eradication of Helicobacter pylori.” Am J Gastroenterol. 2011 Nov;106(11):1970-5:


The experience and outcome of 55 patients with ITP aged 70 or older was compared with much younger ITP patients treated in the same hospital. Although the platelet count at diagnosis didn’t differ significantly between the two groups, those in the older group had more bleeding symptoms, twice as many treatment-related side effects, longer hospital stays, and more disease-related deaths than the younger patients. The study authors conclude that “ITP has a greater impact in the elderly.”

Michel M, et al. “Characteristics and outcome of immune thrombocytopenia in elderly: Results from a single center case-controlled study.” Am J Hematol. 2011 Dec;86(12):980-4:


Hospitals, Insurance, and Medical Care


Doctors, like most of us, are increasing their use of smart phones and other portable electronic devices. While these gadgets can help them view patient records, record data, and have instant access to the latest medical news, there is a potential for harm as well as good. Case reports show that a doctor can be staring at a screen instead of interacting with a critically ill patient…or worse, texting while a patient is hooked up to a dialysis machine or looking up airfares when assisting during an operation.

Richtel M. “As Doctors Use More Devices, Potential for Distraction Grows.” New York Times. December 15, 2011, p A1:


Just before their end-of-year recess, Congress agreed to a two-month postponement of the 27.5% cut in Medicare physician payments due to expire January 1, 2012. This was a temporary measure, allowing time for a Congress-appointed committee to determine a way to fund the current Medicare payment rate for the rest of the year. The American Society of Hematology continues to monitor the Medicare reimbursement issue and encourages physicians to join their grass-roots advocacy efforts.

“Doctors Congress Reaches Last-Minute Agreement to Temporarily Avert Medicare Physician Payment Cuts.” American Society of Hematology, December 23, 2011:


General Health and Medicine


People who eat a diet featuring low-fat dairy products, fruit, whole grains, poultry, fish and vegetables have greater insulin sensitivity and reduced systemic inflammation compared with other eating patterns, concluded researchers after studying the diets of 1751 participants. These ‘healthy eaters’ had lower fasting insulin than the ‘high-fat dairy products’ and ‘breakfast cereal’ groups and lower IL-6, a marker of inflammation, than the ‘sweets and desserts’ and ‘high-fat dairy products’ diet clusters.

Note: ITP has been associated with systemic inflammation and IL-6 has been linked to increased fatigue in ITP patients. For more information on the diet and ITP see:

Anderson AL. et al. “Carbohydrates, Glycemic Index and Diabetes Mellitus Dietary patterns, insulin sensitivity and inflammation in older adults.” European Journal of Clinical Nutrition. (2012) 66, 18–24:


Dark chocolate reduced platelet function and inflammatory markers in smokers but not in healthy adults according to a study that compared the two groups. Before ingesting the chocolate, the platelets of smokers were more reactive and promoted more inflammation than the healthy subjects. Milk chocolate had no effect on platelets in either group. The researchers suggest that polyphenols, substances that are much more prevalent in dark chocolate, were responsible for the changes.

Note: From this study there is no way of assessing the effect of dark chocolate on people with ITP, although there is some evidence from other research that dark chocolate generally impairs platelet response. This study is particularly interesting because it describes how platelets behave differently in smokers. ITP is associated with systemic inflammation and the potential to develop blood clots so both the increased inflammatory markers and the increased platelet reactivity in smokers is not helpful for people with ITP.

Carnevale R, et al. “Dark chocolate inhibits platelet isoprostanes via NOX2 down-regulation in smokers.” Journal of Thrombosis and Haemostasis. Volume 10, Issue 1, pages 125–132, January 2012:



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:, e-mail:


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