Abstract
Background:
The leaves of Carica papaya have been used to treat thrombocytopenia in the critical phase of Dengue fever in areas where the virus is endemic. This case series describes the use of C. papaya leaf liquid extract (CPLE) as an adjunctive therapy for four patients receiving standard-of-care treatment for chronic immune thrombocytopenic purpura (ITP).
Case 1:
A 67 yo M diagnosed with ITP in 1999 presented on 8/17/2013 with bruising and a platelet count of 5 x 103/ml. No response was seen to prednisone 125 mg QD. He subsequently received a course of IV Ig and IV methylprednisolone sodium succinate, but platelet count remained under 5 x 103/ml on 9/13/13. He was prescribed CPLE 3,000 mg QD on 9/30/13. Platelets increased to 148 x 103/ml by 10/8/13 and remained elevated above 250 x 103/ml for five months.
Case 2:
A 21 yo F diagnosed with ITP in 2011 underwent splenectomy on 11/7/13. Despite this intervention, platelet count decreased to 95 x 103/ml on 4/22/14. She was prescribed CPLE 3,000 mg QD as a monotherapy and by 5/8/14, platelet count increased to 156 x 103/ml. CPLE was discontinued and platelet count remained in normal range at 146 x 103/ml on 5/15/14.
Case 3:
A 56 yo M diagnosed with ITP in 2011 was referred for splenectomy on 9/19/12 after his platelet count dropped below 40 x 103/ml despite corticosteroid therapy. Prior to surgery, on 9/30/12, he initiated CPLE 3,000 mg QD in addition to prednisone 10 mg QD. On 11/7/12, pre-surgical labs revealed a platelet count of 115 x 103/ml and splenectomy was cancelled due to adequate platelet count. Platelets remained elevated over threshold for surgery for over four months.
Case 4:
A 60 yo F diagnosed with ITP in 1992 was referred for splenectomy and refused the procedure on 6/5/13. The patient's platelet count was 86 x 103/ml while on prednisone 10 mg QD and she was prescribed CPLE 3,000 mg QD. Her platelet count increased to 109 x 103/ml on 5/12/13 but subsequently dropped to 98 x 103/ml on 5/20/13. CPLE was discontinued at this time due to lack of beneficial action on platelet count.
Conclusion:
CPLE may prove beneficial in the management of refractory ITP for patients interested in alternative therapy before progressing to second-line treatments. Based on the association observed in these cases, a larger clinical trial is warranted to evaluate CPLE as an adjunctive therapy in chronic ITP.
Disclosures
No relevant conflicts of interest to declare.
Central neuraxial blockade in chronic immune thrombocytopenic purpura: Platelet count or function and the concept of rebalanced hemostasis