ascorbic-acid and Purpura--Thrombocytopenic--Idiopathic

An 88 year-old woman was admitted complaining of headache. CT scan of the head revealed a right subdural hematoma. She had been followed by a local physician because of chronic thrombocytopenia. Her peripheral platelet count on admission was 0.5 x 10(4)/microliter, with a high serum level of PAIgG. Bone marrow examination revealed marked increase of megakaryocyte. Idiopathic thrombocytopenic purpura(ITP) accompanied with chronic subdural hematoma was diagnosed. Transient increase of platelet count and improvement of subdural hematoma was obtained by administration of prednisolone. However, platelet count decreased with tapering of prednisolone. Then combined administration of a Chinese herbal medicine, EK-49, and ascorbic acid was started. Platelet count gradually increased and no adverse effects were experienced. These results indicated that elderly patients with chronic subdural hematoma can be treated non-invasively, and that a combination of EK-49 and ascorbic acid may be effective in the treatment of refractory ITP.

Topics: Aged; Aged, 80 and over; Antioxidants; Ascorbic Acid; Drug Therapy, Combination; Drugs, Chinese Herbal; Female; Hematoma, Subdural, Chronic; Humans; Purpura, Thrombocytopenic, Idiopathic

Topics: Ascorbic Acid; Humans; Immunization, Passive; Immunoglobulins; Isoantibodies; Methylprednisolone; Plasma Exchange; Purpura, Thrombocytopenic, Idiopathic; Rho(D) Immune Globulin; Splenectomy; Staphylococcal Protein A; Zidovudine

Topics: Adjuvants, Immunologic; Adult; Ascorbic Acid; Blood Component Removal; Female; Humans; Immunization, Passive; Immunosuppressive Agents; Male; Methylprednisolone; Purpura, Thrombocytopenic, Idiopathic

Topics: Adrenal Cortex Hormones; Ascorbic Acid; Humans; Platelet Count; Purpura, Thrombocytopenic, Idiopathic; Splenectomy; Treatment Outcome

Idiopathic thrombocytopaenic purpura (ITP) is an autoimmune disorder, which causes an acute or chronic thrombocytopenia, and may result in potentially life-threatening haemorrhage. Oxidative damage may be involved in the pathogenesis of autoimmune diseases. Antibodies to bind to membrane lipids and platelet destruction may play a role on lipid peroxidation in ITP.. To investigate the posible role of lipid peroxidation and antioxidants in patients with ITP.. The levels of plasma and erythrocyte malondialdehyde (MDA), erythrocyte glutathione and ascorbic acid were analysed in patients with ITP. METHODS. The MDA levels were performed according to the method of Bidlack WR. Plasma MDA, erythrocyte glutathione and ascorbic acid levels were carried out according to the methods of Ohkawa H, Beutler E and Bauer JD, respectively.. The erythrocyte and plasma MDA levels in patients with ITP were found to be 9.52+/-4.65, 3.03+/-1.44 (p<0.001) and in control group were found to be 2.49+/-0.57, 1.03+/-0.28 nmol/ml (p<0.001), respectively. Erythrocyte glutathione was found to be 3.71+/-0.82, 6.26+/-0.66 micromol/gr Hb (p<0.001). Ascorbic acid levels of these groups were 1.09+/-0.25, 1.70+/-0.33 mg/dl (p<0.001).. The oxidative damage is involved in the pathogenesis of ITP. In patients with ITP, the platelet destruction and bleeding may play significant role on elevation of lipid peroxidation and reduction of antioxidant capacity. Further studies on oxidant and antioxidant status of ITP are also needed to confirm these results.

Topics: Adult; Antioxidants; Ascorbic Acid; Case-Control Studies; Erythrocytes; Female; Glutathione; Humans; Lipid Peroxidation; Male; Malondialdehyde; Middle Aged; Oxidative Stress; Platelet Count; Prognosis; Purpura, Thrombocytopenic, Idiopathic

Topics: Administration, Oral; Adolescent; Ascorbic Acid; Child; Child, Preschool; Chronic Disease; Female; Follow-Up Studies; Humans; Male; Platelet Count; Purpura, Thrombocytopenic, Idiopathic; Remission Induction

From a group of 118 patients with chronic idiopathic thrombocytopenic purpura (ITP), 43 were older than 60 years at diagnosis. In this report, we describe the clinical evolution and therapeutic response in young and old patients. The overal rate of hemorrhagic manifestations was similar in the two age groups, but a greater risk for severe bleeding was observed in elderly patients. There were no significant differences between old and young patients in response to steroids. In none of our patients was mortality associated with bleeding or side effects of the treatment. In conclusion, we have observed a more benign clinical course in elderly patients with chronic ITP as compared to previous reports.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Ascorbic Acid; Child; Child, Preschool; Combined Modality Therapy; Female; Follow-Up Studies; Hemorrhage; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Male; Middle Aged; Platelet Count; Purpura, Thrombocytopenic, Idiopathic; Risk Factors; Splenectomy

Ascorbic acid, reported in 1988 to be effective for idiopathic thrombocytopenic purpura (ITP), is an attractive drug because of its lack of toxicity. Further studies are necessary in order to improve its effectiveness without increasing secondary effects. We present a chronic ITP patient treated with a combination of ascorbic acid and methylprednisolone pulse (MP) therapy who was previously treated with MP therapy alone. The effect of this combination therapy seems to be better than MP therapy alone. This therapy is worth further examination as another therapeutic choice due to its fewer secondary effects than the usual regimen of corticosteroids, splenectomy, and other immunosuppressive drugs.

Topics: Aged; Ascorbic Acid; Drug Administration Schedule; Drug Synergism; Drug Therapy, Combination; Female; Humans; Methylprednisolone; Platelet Count; Purpura, Thrombocytopenic, Idiopathic

Topics: Ascorbic Acid; Humans; Immunosuppressive Agents; Infusions, Intravenous; Interferon-alpha; Platelet Transfusion; Prednisolone; Purpura, Thrombocytopenic, Idiopathic; Splenectomy; Vinblastine; Vincristine

The treatment of corticosteroid- and/or splenectomy-refractory immune thrombocytopenic purpura (ITP) includes vinca alkaloids, immunosuppressives, Danazol, intravenous gammaglobulin, and alpha-interferon. However, these treatments have often been associated with toxic side effects. Brox et al. (Br J Haematol 70:341-344, 1988) reported the efficacy of ascorbic acid in the treatment of ITP; the platelet count normalized in seven of 11 patients studied, and tolerance was excellent. However, other investigators have reported less impressive results. These conflicting reports prompted a pilot study of ascorbic acid in 12 patients with refractory ITP. Patients were given 2 g every morning for at least 10 weeks. All have received glucocorticoids, three had undergone splenectomy, and six received other treatments. The maximal increase in platelet count above baseline (i.e., the prestudy platelet count) achieved was < 20,000 in 11 patients and 25,000 in one patient. Therapy was well tolerated, with only two patients complaining of dyspepsia. The results of this study suggest that ascorbic acid is not very effective in patients with refractory ITP.

Topics: Adrenal Cortex Hormones; Adult; Age Factors; Aged; Ascorbic Acid; Female; Humans; Male; Middle Aged; Pilot Projects; Platelet Count; Purpura, Thrombocytopenic, Idiopathic; Splenectomy

Topics: Adolescent; Ascorbic Acid; Child; Child, Preschool; Chronic Disease; Female; Humans; Male; Platelet Count; Purpura, Thrombocytopenic, Idiopathic

Topics: Ascorbic Acid; Blood Component Transfusion; Danazol; gamma-Globulins; Humans; Immunosuppressive Agents; Infusions, Intravenous; Prednisolone; Purpura, Thrombocytopenic, Idiopathic; Splenectomy; Vincristine

Topics: Adolescent; Ascorbic Acid; Child; Child, Preschool; Female; Humans; Male; Purpura, Thrombocytopenic, Idiopathic