Platelet E-News: July 27th, 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.

Contents:

ITP and Platelet Disorders Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine

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ITP and Platelet Disorders Research and Treatments

 

TO SPLENECTOMY OR NOT: THAT IS THE QUESTION

Prednisone remains the first-line treatment for ITP, but when prednisone fails, and it often does, there is little agreement on what to do next. In years past, there was much agreement…it was prednisone then splenectomy, with little variation. However, with the advent of the thrombopoietin mimentics (NPlate®, Promacta®) and the increased use of rituximab (Rituxan®, MabThera®), the choice is much less clear. Unfortunately, there have been no studies directly comparing the outcomes of these new options to splenectomy or to each other. "As each approach has advantages and disadvantages treatment needs to be individualized, and patient participation in decision-making is paramount."

Ghanima W et al. "How I treat immune thrombocytopenia (ITP): the choice between splenectomy or a medical therapy as a second-line treatment." Blood. 2012 Jun 26. http://www.ncbi.nlm.nih.gov/pubmed/22740443

Read the entire article at http://bloodjournal.hematologylibrary.org/content/120/5/960.full.pdf+html

LOWERING THE DOSE OF RITUXIMAB

Rituximab (Rituxan®, MabThera®) was approved in 1997 to treat B-cell non-Hodgkin lymphomas and administered at a dose of 375 mg/m2 once weekly for four weeks. Years ago when an adventuresome doctor tried an experiment using rituximab on his ITP patient, he used the same dose. In time, more and more doctors mimicked the first success of rituximab for ITP and the lymphoma dose became the usual way of treating the disease. But ITP isn’t B-cell non-Hodgkin lymphoma, so a few researchers have been experimenting with a lower dose (100/mg/m2 for four weeks) for their ITP patients and publishing their results. The most recent study using this lower dose is from China were researchers found that people with ITP treated with 100mg/m2 have nearly comparable rates of success as those treated with the higher lymphoma dose.

Li Y et al. [Clinical efficacy of lower dose rituximab for chronic refractory immune thrombocytopenic purpura]. Zhonghua Xue Ye Xue Za Zhi. 2012 Mar;33(3):204-6.
http://www.ncbi.nlm.nih.gov/pubmed/22781608

For more information about rituximab as a treatment for ITP and links to other research using the lower dose see:
http://www.pdsa.org/treatments/conventional/b-cell-depletion.html

NEW SPONGE COATING STOPS BLEEDING

Stopping excessive bleeding is a big worry for people with ITP. And it is also a huge problem in operating rooms, at the scene of accidents, and on the battlefield. Fortunately scientists at the Massachusetts Institute of Technology have developed a new bleed-halting product that works much better than those currently available: sponges sprayed with nano-particles composed of very small bits of thrombin (a blood-clotting protein) and tannic acid (an anti-bacterial substance found in black tea). These new sponges are easy to transport and can stop bleeding almost instantly, giving them a big advantage over other methods that require thrombin to be placed on a sponge at the time of use or tourniquets which can't be used on the neck. In a controlled test on a severely injured pig, the new sponges stopped bleeding much faster than other methods.

Sarao A. "Nanoscale Biocoatings to Stop Bleeding in Seconds." The Epoch Times. June 17, 2012. http://www.theepochtimes.com/n2/science/nanoscale-biocoatings-to-stop-bleeding-in-seconds-186919.html

PARSLEY, THE NEW PREDNISONE?

Parsley has been used for years as a folk remedy for water retention, coughs, allergy, autoimmune, and chronic inflammatory disorders. Although it is one of the most potent disease-fighting plants little is known about how parsley works its magic….that is, until now. Recently, scientists set out to examine just one of the many wonders of parsley, its immune effects, in rigorous scientific detail. They looked at how parsley oil interacts with T-cells and B-cells (both types of white blood cells) and macrophages (cells that engulf and eliminate other cells). Conclusion: parsley oil acted in a similar way to drugs that suppress the immune system, like prednisone, but without the harmful side effects. As if that weren't enough, other studies have shown that parsley has antitumor, antibacterial, and antioxidant properties.

Karimi MH et al. "Parsley and immunomodulation." Expert Rev Clin Immunol. 2012 May;8(4):295-7. http://www.expert-reviews.com/doi/pdf/10.1586/eci.12.12

 

Hospitals, Insurance, and Medical Care

PATIENTS GAIN AT THE FDA

Now it's official. With the passage of the FDA Safety and Innovation Act, the FDA will be implementing a plan (due October, 2013) to include more patient input in their approval process and provide a better explanation of the risk/benefit tradeoffs of the drugs they approve. To be fair, the FDA has been working on this plan (they call it a framework) and implementing part of it for a while. They recognized that the priorities of sick people may be very different from the priorities of the healthy reviewer and also saw a need to be more transparent in their approval process. More good news: the approval explanations will be in words, not obscure statistics.

Maxmen A. "Law spurs regulators to heed patients' priorities: US FDA to consider risks and benefits more explicitly in drug approvals." Nature. 10 July 2012. http://www.nature.com/news/law-spurs-regulators-to-heed-patients-priorities-1.10969

USA.GOV: More Health Info on the Web

The US government has several agencies devoted to helping people lead a healthier life…FDA, NIEHS, NIH, CDC… each with its own acronym, purpose, Web site, and way of organizing information. Recently the government updated the Health and Nutrition section of the USA.gov Web site to make it easier to find material across the array of government agencies. To see this process in action go to http://www.usa.gov/Citizen/Topics/Health.shtml or just explore USA.gov.

 

General Health and Medicine

MAGNESIUM PREVENTS STROKES

Low platelets do not protect people from heart and blood vessel problems so it is important for everyone to pay attention to their cardiovascular health. A Japanese study found that people who had a higher intake of magnesium in their diet also had a reduced risk of cardiovascular disease and men had a reduced risk of strokes caused by bleeding in the brain. However, other studies show that magnesium only reduces strokes caused by blood clots. Whichever type of stroke it reduces, getting enough magnesium in your diet is a good thing since it improves overall cardiovascular health. Be sure to eat plenty of green leafy vegetables, nuts, seeds, and beans to boost your intake of this important nutrient.

Zhang W et al. "Associations of dietary magnesium intake with mortality from cardiovascular disease: the JACC study. Atherosclerosis. 2012 Apr;221(2):587-95." http://www.ncbi.nlm.nih.gov/pubmed/22341866

SUMMER FUN: DIRTY BEACHES, CARCINOGEN COKE, TOXIC SUNSCREEN, BBQ PUNCTURES

Going for a swim? According to the National Resources Defense Council our public beaches continue to be polluted and put bathers at risk. You can check http://www.nrdc.org/water/oceans/ttw/default.asp to learn more about the contamination rating of the beach or great lake near you.

Cooling off with a soda? The formula for Coca-cola was recently changed in California to contain smaller amounts of the cancer-causing chemical 4 methylimidizole (4-MI) after the state required a cancer warning for the previous formula. However, the levels of 4-MI in Cokes sold in other states and in other countries remains high. The carcinogens come from processing the caramel color used to darken the drink, so Pepsi and perhaps other sodas have the same problem.

Slathering on the sunscreen? Only one in four sunscreens earns high marks for being safe and working well. Some can actually promote cancer, disrupt the endocrine system, or prompt an allergic reaction. You can check the safety of your favorite sunscreen or find a new one at http://breakingnews.ewg.org/2012sunscreen/

Firing up the grill? No one wants a dirty grill so most people scrub the rungs with a wire brush. But beware: the wire bristles can stick to the grill and be caught in the next batch of burgers. Eating the bristled food can cause huge problems such as puncturing parts of the gastrointestinal tract.

"Tests Show Carcinogen Levels in Coca-Cola Vary Worldwide: Coca-Cola Sold in Brazil is Most Contaminated." Center for Science in the Public Interest. http://www.cspinet.org/new/201206261.html

"Injuries from Ingestion of Wire Bristles from Grill-Cleaning Brushes — Providence, Rhode Island, March 2011–June 2012." Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. July 6, 2012 / 61(26);490-492. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6126a4.htm

 

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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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