PDSA E-News: August 31, 2014


Combined IVIg and Steroid Treatment Benefits Children with Primary ITP

286It is scary when children with ITP have persistent bleeding. There is good news from a study of 34 children with primary immune thrombocytopenia who had persistent bleeding symptoms. Researchers found that a combination therapy of IVIg and steroids was effective in raising their platelet counts (to 50,000 or higher) to control active bleeding. The combined treatment was considered well-tolerated by the patients. Combined therapy was given to 12 patients with newly diagnosed ITP who had not responded to treatment with either IVIg or steroids and to 22 patients with persistent, chronic ITP who had needed frequent treatments of either steroids or immunoglobulins to control active bleeding.

Prodi E, Giordano P, Rivetti E, et al., "Efficacy of combined intravenous immunoglobulins and steroids in children with primary immune thrombocytopenia and persistent bleeding symptoms." Blood Transfus. 2014 July: 12(3): 340-345.

Self-Administration of Nplate® Found Just As Effective and Safe as Administration by Healthcare Providers

287Outcomes were analyzed from three ITP trials that allowed self-administration (SA) of romiplostim (Nplate®) injections versus administration by a healthcare provider (HCP) in a clinical setting in ITP patients who had achieved stable dose for 3 or more weeks. The self-administered groups had greater percentage of patients achieving the target platelet range (55-58% in SA vs 40-52% in the HCP) and a greater percentage of weeks with a platelet response (75-78% vs 47-76%, respectively). In addition, the rate of romiplostim discontinuation was lower in the self-administered group. Researchers concluded that in adult patients receiving romiplostim, self-administration compared well to healthcare provider administration when it came to effectiveness and safety. Allowing ITP patients to self-administer romiplostim is a feasible option for certain ITP patients.

Selleslag D, Bird R, Altomare I, et al., "Impact of self-administration of romiplostim by patients with chronic immune thrombocytopenia compared with administration by a healthcare provider." Eur. J. Haematol. 2014, July 14, [Epub ahead of print]


Hospitals Cut Costs by Finding Ways to Save Money on Blood Storage and Usage

Blood is among the most precious and most perishable of commodities in health care. Red cells may last five weeks, but platelets which are key to clotting and preventing bleeding, last less than a week. Because of short shelf life of blood products hospitals across the country waste huge amounts of blood worth millions of dollars annually.

At the University of Pittsburg Medical Center (UPMC) ways are being found to reduce this waste. Buying and storing only what the hospital needs is key but with platelets that is easier said than done. Platelets have the shortest shelf life of any blood cells, and are very temperature sensitive. If frozen or even refrigerated the transfused platelets will leave the person's system too quickly. UPMC redesigned their blood supply chain and changed the standards of when patients would require a blood transfusion. They reduced the number of blood donations by patients prior to operations, which the hospital found were unused in 50% of cases and had to be thrown out, wasting thousands of dollars.

"Bill Tolland, "UPMC is finding ways to squeeze savings, prevent waste." Pittsburgh Post-Gazette, 2014 July 29.


Celery - Not Just For Dieters Anymore

celeryWe know because celery is low in calories (16 calories per cup) it has been popular with dieters. But there's much more to celery than people realize. Celery is an excellent source of fiber that lowers risk for colon cancer. The bright green vegetable offers 8-9 percent of the daily requirement for vitamin A, folate, and potassium. It contains smaller amounts of manganese, copper, magnesium, and calcium, plus vitamin C, B6, and niacin. Most surprising, one cup of celery contains 37 percent of the daily requirement for Vitamin K, which people with ITP know is an important vitamin for production of healthy platelets.

Celery contains flavonoids like lutein and beta carotene that studies have shown lower inflammation and enhance the immune system. Recent studies found that celery reduced memory loss and brain inflammation in mice. For centuries Ayurvedic medicine has used celery for colds and flu, digestion problems, and liver and spleen disorders. So go ahead and enjoy crunchy fresh celery in your next salad, stir fry, soup, or veggie tray!

"What is Celery Good For?" Dr. Mercola Online newsletter, August 8, 2014.

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