Dentoalveolar procedures in immune thrombocytopenia; systematic review and institutional guidelines

Background Dentoalveolar procedures in immune thrombocytopenia (ITP) pose a risk of bleeding, due to thrombocytopenia, and infection, due to immunosuppressive treatments. We aimed to systematically review the safety and management of dentoalveolar procedures in ITP patients in order to create practical recommendations. Methods Pubmed, Embase, Cochrane and Cinahl were searched for original studies on dentoalveolar procedures in known primary ITP patients. We recorded bleeding- and infection-related outcomes and therapeutic strategies. Clinically relevant bleeding was defined as needing medical attention. Results Seventeen articles were included, of which twelve case reports/series. Overall, the quality of the available evidence was poor. Outcomes and administered therapies (including hemostatic therapies and prophylactic antibiotics) were not systematically reported. At least 73 dentoalveolar procedures in 49 ITP patients were described. The range of preoperative platelet count was 2-412*109/L. Two clinically relevant bleedings (2%) were reported in the same patient, of which one was life-threatening. Strategies used to minimalize the risk of bleeding were heterogeneous and included therapies to increase platelet count, antifibrinolytics, local measures and minimally invasive techniques. Reports on the occurrence of bleedings due to anesthetics or infection were lacking. Conclusion Based on alarmingly limited data, clinically relevant bleedings and infections after dentoalveolar procedures in ITP patients seem rare. Awaiting prospective and controlled studies to further evaluate these risks and the efficacy of therapeutic interventions, we provided our institutional guideline to guide the management of dentoalveolar procedures in ITP patients.

Eltrombopag for the treatment of the inherited thrombocytopenia deriving from MYH9 mutations

Platelet transfusion is currently the primary medical treatment for reducing thrombocytopenia in patients with inherited thrombocytopenias. To evaluate whether stimulating megakaryopoiesis could increase platelet count in these conditions, we treated patients with a severe thrombocytopenia induced by MYH9 mutations (MYH9-related disease) with a nonpeptide thrombopoietin receptor agonist, eltrombopag. Twelve adult patients with MYH9-RD and platelet counts of less than 50 × 109/L received 50 mg of eltrombopag orally per day for 3 weeks. Patients who achieved a platelet count higher than 150 × 109/L stopped therapy, those with 100 to 150 platelets × 109/L continued treatment at the same eltrombopag dose for 3 additional weeks, while those with less than 100 platelets × 109/L increased the eltrombopag dose to 75 mg for 3 weeks. Major responses (platelet count of at least 100 × 109/L or 3 times the baseline value) were obtained in 8 patients, minor responses (platelet counts at least twice the baseline value) in 3. One patient did not respond. Bleeding tendency disappeared in 8 of 10 patients with bleeding symptoms at baseline. Mild adverse events were reported in 2 patients. The availability of thrombopoietin mimetics opened new prospects in the treatment of inherited thrombocytopenias. This study is registered at www.clinicaltrials.gov as NCT01133860 (European Union Drug Regulating Authorities Clinical Trials number 2008-001903-42).

Study on the effect of the water and erhanolicextract of Equisetum arvense L. on some Hematological Parameters in the Albino mice

The present study has been performed on the vegetative parts of the local Horsetail Equisetum arvense L., which grow naturally in Haj Umran in the north of Iraq, to assess the effect of crude extracts of this plant on some hematological parameters in vivo. The results revealed that the crude extracts (water and ethanolic), significantly, increase the lymphocyte level in vivo especially in concentration(50 mg/ml), the results also showed that the crude extracts (water and ethanolic) of (10, 50 mg/ml), significantly, increase the red blood corpuscles count in vivo, while higher concentration (100 mg/ml)has areverse effect(decrease the count), while the crude extracts (water and ethanolic)of (10 ,50 mg/ml), significantly, increase the amount of hemoglobin in vivo, where as higher concentration of(100mg/ml) decrease it. Finally, the low concentration of crude extracts(water and ethanolic) were efficient to increase platelet count in vivo, However, higher concentration of (100 mg/ml)decrease it.

Chronic immune thrombocytopenic purpura

SummaryFirst generation thrombopoietic growth factors (rhTPO and PEG-rHuMGDF), investigated in the early 2000s, proved effective in increasing platelet count in normal volunteers, in thrombocytopenia due to chemotherapy and also in a few cases of immune thrombocytopenic purpura (ITP). These agents did not complete their clinical development since one of them induced antibodies in the recipients that cross reacted with endogenous thrombopoietin (TPO), thus causing thrombocytopenia. This promoted the ingenious design of a new generation of thrombopoietic growth factors having no sequence homology with natural TPO. The two main agents are romiplostim, a peptibody already approved for clinical use in USA and eltrombopag, a non-peptide, orally active small molecule. In open label and placebo-controlled trials both agents proved to predictably increase platelet count in normal volunteers and in patients with ITP. With appropriate dosages (1–10 µg/kg weekly sub cutaneously for romiplostim; 50–75 mg/die per os for eltrombopag ) a platelet increase becomes significant after 7–10 days and peaks between 10–14 days. By dis -continuing treatment, platelet count returns to baseline level in 10–15 days. The response rate with both agents is above 70–80%, also in patients that had undergone several lines of treatment, or that have failed splenectomy. The response is maintained during the treatment, but is almost invariably lost even after several months of successful administration. Due to the lack of a curative potential and to the incomplete knowledge of long-term side effects, the place of these new drugs in the management of ITP is still unsettled and their use is best restricted to refractory patients or in preparation of splenectomy. It seems however that a new paradigm in the treatment of ITP has been established where the focus is not on reducing platelet consumption but on increasing platelet production.

The Importance of Platelet Counts in Dengue Infection: 35 Cases and Literature Review

Dengue infection is a major vector-borne disease. The classical form of this infection has an incubation period of 5 to 8 days followed by fever, violent headache, and chills, with rash developing after 3 to 4 days. A summative report on the platelet count and its clinical correlation to duration of fever in 35 Thai children is presented. Most of the subjects visited to the physician with a complaint for fever. Most patients went to see the physician between the 3rd and the 5th day from the onset of fever. There is no significant correlation between platelet count and duration of fever (ANOVA test, p = 0.28). However, there is a trend of increase platelet count in the later days. In addition, an overview on the previous literatures on platelet count and dengue infection is presented.