#mypurplepatch

[anthonypaulh]

At this time of year we ITP folk in the Northern hemisphere need to consider taking a Vitamin D supplement as we say goodbye to sunny days and hence the natural absorption of Vitamin D from those rays.

The article above explains why Vitamin D is important, where we can get it from and who may be at risk when not getting enough of it.

SUNSHINE on A RAINY DAY - The Importance of Vitamin D

For those of us living in the Northern Hemisphere we are all too aware of our long Winters. That miserable time between the end of September and the beginning of April when we are starved of sunshine. All our pictures seem to fade to black and white !

Here in the UK, one of our national pastimes is talking about the weather but I am sure that few people actually know the implications of a lack of sunshine on our health.

It is our reduced supply of vitamin D that is impacted by the lack of sunshine that we get during the Winter months that causes us a problem. It can have potentially dangerous implications for our health.

We can synthesise vitamin D3 in our skin from sunshine and this is our main source of vitamin D. However, in the UK and anywhere in the Northerly latitudes for that matter this is only possible in the summer months (between April and September) during the hours around midday (around 11am-3pm), when sunshine contains sufficient UVB light (290-315 nm). 

During the winter months (October to March), vitamin D can only be obtained from our diet (and supplements), but only a relatively small number of foods contain vitamin D.

So why is Vitamin D important to our health and what problems can it lead to if we do not obtain enough of it ? 

 Vitamin D is needed for maintaining the balance of calcium and phosphorus in the body, It is essential for keeping bones and muscles healthy. Vitamin D has also been investigated for its’ potential role in reducing the risk of diseases, including diabetes, high blood pressure, cardiovascular disease, cancer and Covid-19 and for its’ role in immunity as a whole. But clear evidence is unproven in many of these areas and more research is ongoing.

Vitamin D deficiency can lead to a loss of bone density which can contribute to osteoporosis and broken bones.Severe vitamin D deficiency can also lead to other diseases. In children, it can cause rickets which is a rare disease that causes the bones to become soft and bend. In adults, severe vitamin D deficiency leads to osteomalacia which causes weak bones, bone pain, and muscle weakness.

There are surprisingly few sources of vitamin D in our food and so without the sunshine levels that we get in our Summer months we will almost certainly see our levels  become low during the Winter months, unless we take a supplement.

Good sources of vitamin D from our food are -

Oily fish – such as salmon, sardines, herring and mackerel

Red meat

Liver

Egg yolks

Fortified foods – such as some fat spreads and breakfast cereals. Check the labels !

Without sunshine on our many rainy days we are well advised to take a vitamin D supplement. This is the reason why the UK Government has offered free of charge, a supply of vitamin D supplement tablets to all those of us who are in the clinically extremely vulnerable group during the current Covid-19 pandemic.

For those of us in the clinically extremely vulnerable group it means that because we are spending more of our time indoors (even during the Summer months) we are more likely to be short of vitamin D and this will of course have implications for our overall health.

I take a vitamin D supplement during the Winter and always have done. From October 1st until May 1st I take a 10ug vitamin D supplement tablet. This is certainly supported by Public Health England who recommend a supplement is taken during these months, when vitamin D synthesis in the skin is not possible. 

At risk groups, including people who do not often go outdoors, who reside in an institution such as a care home, or those who normally cover most or all of their skin when outdoors, should take a daily 10 microgram vitamin D supplement throughout the year.

 People with dark skin, including individuals from Black and Minority Ethnic (BAME) groups (e.g. individuals of African, African-Caribbean or South Asian background), should consider taking a vitamin D supplement all year round, as they may not be able to get enough vitamin D from sunlight exposure during spring and summer. 

So there we have it, when there is no sunshine because of our rainy or Winter days, we need to do something to boost our vitamin D levels. Taking a supplement of 10ug per day should be sufficient for most of us during the Winter months. This should make up for the lack of the vital vitamin D we can obtain form the sunshine we might get during the Summer. Eating a sensibly, balanced diet will also help too.

Sunshine on a rainy day ? Well definitely, possibly, maybe but do take a vitamin D supplement just to make sure !

Some useful sources of information on Vitamin D

https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/ 

https://www.bbc.co.uk/news/health-52371688 

https://www.bbc.co.uk/news/health-55108613 

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[anthonypaulh]

IN PLATELETS AGE and SIZE REALLY DOES MATTER

All of us purple people know that ITP is a condition where, even though our platelet production is increased from our bone marrow, our misguided immune system destroys platelets even more rapidly hence leading to thrombocytopenia and the tell tale symptoms we all recognise. 

Right so far are you with me ? OK…. well we have also discovered that in general and I say the words again to emphasise the point..IN GENERAL, we folk with ITP do not have the same bleeding tendency as those with the same degree of thrombocytopenia caused by a bone marrow issue/problem. 

So we purple folk in general don’t tend to bleed as much as those with bone marrow/platelet production issues. Our problem is one of destruction rather than production (in general terms). Also the platelet count in us purple people is actually a poor predictor of whether or not we are actually likely to suffer any bleeding be it internal (brain bleeds or internal organs) or external (nose bleeds, gum bleeds etc).

So what does all this mean ? In a nutshell in ITP because we are having to produce so many more platelets because our misfiring immune systems keeps destroying them it means a much higher proportion of our platelets are YOUNG. Well so what one might say ? Well so good actually. Younger platelets are more capable of stopping bleeding than older ones and this may explain the general tendency for less bleeding in ITP patients than those with platelet production/bone marrow deficiencies.

So in platelets the younger the better and so platelet age really is a definite factor. But it’s not just about age, it’s also a size issue too. Platelets decrease in size as they get older so the younger platelets are bigger and are therefore more effective in the clotting process. 

Now there is a test which can be done to measure the average size of our platelets called the Mean Platelet Volume (MPV). It takes into account the different sizes of platelet circulating in our blood. So if the younger platelets are more predominant our MPV will be greater but if the number of younger platelets is fewer our MPV will be lower. 

It is as if the ITP Gods have granted us a back handed bonus, a compensatory gift of younger, bigger more efficient platelets in exchange for mistakenly destroying them. One heck of a quid pro quo !

In ITP sufferers our MPV is normally higher than average  (again I use the words normally higher with caution) . Now this measure should not be looked at in isolation and cannot be relied upon in itself BUT it can be viewed at in combination with other evidence/symptoms that the patient is showing. 

Just to get a bit more complicated here is another set of initials to get thinking about in respect of the age of our platelets…. IPF which stands for Immature Platelet Fraction. This looks at the number of young platelets circulating in our blood system and it can give an indication of whether or not there is a likelihood that even with a low platelet count there is likely to be bleeding or not. 

With IPF and MPV all this is just another aspect of estimating/predicting whether or not the patient is at risk from bleeding or at least getting a better idea of the bleeding propensity.

So what can we conclude about the age of our platelets ? 

1. In general YOUNG platelets are more plentiful in ITP sufferers because we produce more of them to replace those being destroyed by our misfiring immune systems.

2. YOUNG platelets tend to be bigger and therefore are more efficient in the clotting process.

3. Testing can be done in the lab to check the volume of YOUNGER platelets and age of them in our systems. Hence it gives more information to our specialists when they consider whether or not we each have a greater or lesser propensity to bleed even with lower platelet counts.

4. This is an area still developing all the time and we are getting more ammunition to be able to design treatments specifically for patients as individuals. 

5. Age and Size really does matter with platelets.

As we are discovering more about our illness we are hopeful to better tailor treatments to the individual sufferer with more precision .

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