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Alert Number 304

ITP: It Really Helps to Get Rid of the Bugs in Your Stomach

Date: November 3, 2008

A while back I wrote a full length article on the subject of ITP – immune thrombocytopenic purpura. Along with AIHA (autoimmune hemolytic anemia), ITP is a frequent complication that can make life with CLL much worse than it is already.

ITP patients can have alarmingly low platelet counts – as a result of their own immune system going bonkers and killing perfectly good platelets, faster than their poor bone marrow can produce replacements. Low platelets can lead to severe bleeding problems. The smallest paper cut can become a major issue. More important, internal bleeding has the potential of becoming lethal. Uncontrolled ITP can quickly overtake CLL as the focus of your worries. CLL patients who are "doubly blessed" (not!) with ITP have worse survival prognoses, as you can see from the graph below (source article cited in our review is here.)

Helicobacter pylori – Can this Bug Increase Your Chances of Getting ITP?

One of the more exciting findings in recent years has been that H. Pylori, the ubiquitous bug present in most of our stomachs may be implicated in triggering or making ITP worse. The case has been made by some researchers that H.pylori eradication (by means of broad spectrum antibiotics, nothing more drastic than that) can help ITP patients. As we know all too well by now, medical science moves at a glacial pace and the concept of H.pylori eradication as a way of treating ITP patients has yet to gain "best practices" status.

Below is a brand new abstract (let me know if you want to read the full text) in the prestigious journal "Blood" that might get us a little closer to acceptance of this concept. This is a large study looking at all the available data. 20% of patients had a complete response, 35% had a partial response. Beats a kick in the head, if you ask me. I quote: "These findings suggest that the detection and eradication of H. pylori infection should be considered in the work-up of patients with seemingly typical ITP."

Even after the researchers at expert centers get on board, it will be a long while before the precious knowledge trickles down to the local level. If you are a CLL patient with ITP, I strongly urge you to become proactive about this issue. If you wait around for your local oncologist to get this point from his/her next scheduled CME (continuing medical education) program, chances are you would have wasted precious time. Autoimmune disease is like bad habits. Teaching your body to forget bad habits (like killing innocent platelets just for the heck of it) is much easier when the bad habits are not well established over many moons. Anyone who has tried to quit smoking will tell you that! AIHA and ITP can be life threatening complications in CLL and you don’t want these bad habits to become the norm for your body.

Be well,


Blood. 2008 Oct 22.

Effects of eradication of Helicobacter pylori infection in patients with immune thrombocytopenic purpura. A systematic review.

Stasi R, Sarpatwari A, Segal JB, Osborn J, Evangelista ML, Cooper N, Provan D, Newland A, Amadori S, Bussel JB.

Department of Medical Sciences, Ospedale "Regina Apostolorum", Albano Laziale, Italy.

Whether the eradication of Helicobacter pylori (H. pylori) infection can increase the platelet count in patients with immune thrombocytopenic purpura (ITP) is still a controversial issue. To provide evidence based guidance, we performed a systematic review of the literature published in English selecting articles reporting 15 or more total patients. We identified 25 studies including 1555 patients, of whom 696 were evaluable for the effects of H. pylori eradication on the platelet count. The weighted mean complete response (platelet count >/=100 x 10(9)/L) and overall response (platelet count >/=30 x 10(9)/L and at least doubling of the basal count) were 42.7% (95% CI, 31.8% to 53.9%) and 50.3% (95% CI, 41.6% to 59.0%), respectively. In 222 patients with a baseline platelet count <30 x 10(9)/L the complete response rate was 20.1% (95% CI, 13.5% to 26.7%) and the overall response rate was 35.2% (95% CI, 28.0% to 42.4%). The response rate tended to be higher in countries with a high background prevalence of H. pylori infection and in patients with milder degrees of thrombocytopenia. These findings suggest that the detection and eradication of H. pylori infection should be considered in the work-up of patients with seemingly typical ITP.

PMID: 18945961

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