Low Platelets

Hello,

I was diagnosed with end stage cirrhosis back in March 2010. My last lab test revealed my platelet count is down to 60k. I have concerns since I read I could be heading for real trouble at around 20k. I have splenomegaly (enlarged spleen) which I think is directly responsible for the low platelet count. Any suggestions I would sure appreciate.
Thx

Randy

[HectorSF]

Hi Randy.

I wanted to mention the standard treatment to prevent variceal bleeding.
All quotes are from the AASLD Practice Guideline for for managing Varices.

'Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis'

http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/Prevention%20and%20Management%20of%20Gastro%20Varices%20and%20Hemorrhage.pdf

Recommendations

8. In patients with medium/large varices that have not bled but have a high risk of hemorrhage (Child B/C or variceal red wale markings on endoscopy),
nonselective
-blockers (propranolol or nadolol) or EVL may be recommended for the prevention of first variceal hemorrhage (Class I, Level A).

9. In patients with medium/large varices that have not bled and are not at the highest risk of hemorrhage (Child A patients and no red signs), nonselective
-blockers (propranolol, nadolol) are preferred and EVL (banding) should be considered in patients with contraindications or intolerance or non-compliance to
-blockers (Class I, Level A).

10. If a patient is placed on a nonselective
-blocker, it should be adjusted to the maximal tolerated dose; follow-up surveillance EGD is unnecessary. If a patient is treated with EVL, it should be repeated every 1-2 weeks until obliteration with the first surveillance EGD performed 1-3 months after
obliteration and then every 6-12 months to check for variceal recurrence (Class I, Level C).

11. Nitrates (either alone or in combination with
-blockers), shunt therapy, or sclerotherapy should not be used in the primary prophylaxis of variceal
hemorrhage (Class III, Level A).

What this is saying is that all patients with varices should be taking a beta-blocker to prevent the first bleed. It reduces the portal hypertension that we with scared livers have. Why is this important and basic treatment for all cirrhotics? Because once we bleed the chances of future bleeds goes way up. All pretransplant patients that I know use them. I have been taking Nadolol for 3-4 years now and have no bleeds. It is the only proven way to prevent bleeds other than banding which is the next thing to be done before bleeding. Bleeding from varices is a potentially life-threatening complication of cirrhosis. You can actually lose most of the body's blood during a bleed.

'Patients who survive an episode of acute variceal hemorrhage have a very high risk of rebleeding and death. The median rebleeding rate in untreated individuals is around 60% within 1-2 years of the index hemorrhage, with a
mortality of 33%.'

'Nonselective
-blockers have no role in the prevention of the development of esophagogastric varices but are the gold standard in the prevention of first variceal hemorrhage in patients with medium/large varices. Endoscopic variceal ligation (banding) has been established as an alternative to nonselective
-blockers for the prevention of initial variceal hemorrhage.'
----------------------------------------------------------------------------------
I am glad you are in Memphis where you will be able to see a hepatologist.
Methodist is where Steve Jobs had his liver transplant.

Maybe you can get a referral from your current doctor to have the transplant center do an evaluation so you know what options are available to you.

Methodist University Hospital Transplant Institute
1265 Union Ave.
Memphis, TN 38104

http://www.methodisthealth.org/healthcare-services/transplant-institute/organ-transplant-outpatient-clinic/

Transplant Outpatient Clinic

Pre-Transplant Evaluation

A good candidate for a transplant is determined by a full medical evaluation and input from several medical professionals. The transplant team performs this evaluation in the Pre-Clinic. This team is composed of the transplant surgeon, hepatologist/nephrologist, pre-coordinator nurse, financial case manager, and social worker.

Evaluation Process

The evaluation process begins with a referral from a potential candidate's primary care physician. The candidate then answers a variety of health and lifestyle questions. This information helps the transplant team decide the eligibility of the transplant candidate.

During an initial visit, a transplant candidate will meet with a financial coordinator and a social worker and receive detailed information about the transplant process. For those who are identified as potential candidates, a complete medical evaluation is performed. The medical evaluation is a series of tests dependent upon the specifics of each case. The surgeon reviews the results of this medical examination to further determine eligibility. If the evaluation indicates the candidate is appropriate for transplantation, staff members work with the patient to finalize financial arrangements.

The candidate will receive written confirmation and be listed with the United Network for Organ Sharing (UNOS), a non-profit scientific and educational organization that administers the only national patient waiting list. Once listed with UNOS, patient evaluations must be performed at regular intervals to determine continual eligibility for transplantation. Should an organ become available, it is offered to a patient on the list based on a defined set of criteria established by UNOS.
------------------------------------------------------------------------------------------
Local Support Group

Get the support you need with Living Kindly, monthly support group sponsored by Methodist Healthcare. The group is open to caregivers, family members, transplant candidates, donors and those who have had a transplant. You will have access to knowledgeable speakers discussing a variety of subjects, such as medication side effects, living donation, financial concerns, blood donation and maintaining a healthy lifestyle.

Methodist University Hospital Transplant Institute staff is on hand at each meeting to offer support, share their knowledge and answer any questions you might have. More importantly, other transplant donors and recipients are available to share their transplant experiences or provide mutual peer support to you and your family.

Not a joiner? That's okay. You are welcome to attend and listen. Living Kindly is designed to give donors and recipients access to as much information as possible to assist with their transplantation journey.

The group currently meets the second Thursday of each month in Stratton Auditorium, which is located at Methodist University Hospital (1265 Union Avenue). The class starts at 3:30 p.m., with a medication education session beginning at 3 p.m.

Food and beverages are served and parking is free.
-------------------------------------------------------------------------------
I would highly recommend you meet others who are waiting for transplants. It is a good way to learn a lot and you will see that many others are going through what you are going through.

Cheers!

Hector

[orphanedhawk]

I know you're right about your splenomegaly being responsible for your low platelet count.
I had a liver transplant but the spleen does not return to it's normal size post transplant, so my platelets tend to run on the low side too.
The problem with having very low platelets, in the 20s, is that if you were in an accident you could bleed to death internally. My hepatologist said the problem is not about simply having a cut.

Those of us doing hep C treatment often have low platelets. Unfortunately I know of no way to raise platelet count.

Since it can take the liver quite some time to repair itself from cirrhosis, I'm guessing that as your liver heals, your platelet count will improve.

Somewhat off topic: Do you know how damaged your liver became prior to stopping your drinking ? Did you have a biopsy ? If so when and what were the results ?

[HectorSF]

Hi Randy.

Splenomegaly is a common complication of cirrhosis.

Many cirrhotics have platelet counts in the 60,000s.Including myself for at least 2-3 years.

It is not something to worry about. And it doesn't need to be treated. You have plenty of platelets to properly clot your blood. The biggest issue with low platelet counts is that hepatitis C treatment that includes interferon reduces platelet counts even more and may reduce the platelet count to dangerously low levels below 20,000 in cirrhotics.

Platelet transfusions and Promacta (which is currently seeking FDA approval for use during hep C treatment) can raise platelets on a temporary basis and can help hepatitis C patients get through treatment if they have responded to treatment and clear the virus.
---------------------------------------------------------------------------------------
Why platelet counts become low in cirrhotics:

Blood flows from the spleen...through the portal vein...then through the liver.
Scar tissue in the liver (cirrhosis) can interfere with that blood flow, causing pressure to build up in the portal vein (portal hypertension), and the spleen to enlarge (splenomegaly).

As the spleen enlarges, it traps platelets. (The amount of platelets in the bloodstream is reduced because the spleen is busy trapping them).
So usually---people with cirrhosis end up having a problem with portal hypertension and an enlarged spleen, and a reduced platelet count in the bloodstream.

As time goes by, the liver may try to repair itself by growing new cells. If there is a lot of scar tissue already present--- the new cells grow between scar tissue (and result in abnormal nodules). The nodules and scar tissue further interfere with blood flow through the liver. So over time people with advanced cirrhosis can end up having a problem with more and more abnormal nodules and scar tissue forming...which interferes even more with blood flow through the liver.....which makes the spleen continue to enlarge....and the platelet count continue to drop.

Cheers!
Hector

[rpooo]

Thank you very much for your responses! Also welcome to MedHelp's cirrhosis of the liver community!

In the beginning my MELD was calculated to be around 15. Today I am at 9 :) Never biopsied/CT Scan was performed for diagnosis March 2010. I have avoided folic acid although recommended by my doctor to increase cell reproduction. I found early on that this could cause more problems than good under my circumstances such as cancer. I am screened every 6 months.

I have always used vitamin C with rosehips to strengthen the walls of my blood vessels (grade 3 varices) and assist with my platelet count. I am very fortunate to never have needed banding.

I recently was reading that antioxidants can play a key role in helping a low platelet count. Red foods are key. Tomatoes, plums, watermelons, cherries and berries are loaded with vitamins and minerals and have strong anti-oxidant properties which helps to stop platelets from being destroyed.

Avoid all refined and processed foods – sugar, saturated fats, and aerated drinks. Include fresh and organic foods. This will help in stimulating the body’s internal mechanism and increase platelet count.

Am I on the right track here?

[orphanedhawk]

Gee, I dunno, but I never had any problem with varicies and I never took vitamin C;
Can't say if it was because of my diet or just luck of the draw.
Of course eating a healthy diet, staying away from processed foods, is always best.
I read beets and artichokes are liver healthy foods. Although I never liked beets I learned to eat them by making them with grated fresh ginger and olive oil.
It makes sense that to help a scarred liver, to avoid processed food and eat as organically as possible.
A doctor told me egg whites and tofu were good for albumin levels.

What I do know is if the cirrhosis is decompensated you should avoid salt and red meat.

[HectorSF]

Since you have cirrhosis, you should be under the care of a hepatologist at a transplant center. All changes in diet, drugs, vitamins, supplements should be cleared by your hepatologist first as many are toxic to the liver when a person has cirrhosis.

Taking vitamin C can increase iron levels.

Iron and Vitamin C
http://www.hepatitis.va.gov/patient/diet/supplements.asp

'Some people with hepatitis C, particularly those with cirrhosis, have above-average levels of iron in their body. Too much iron can damage organs. If these people take multivitamin/mineral pills, they should take the ones without iron. These pills usually are marketed as formulas for men or adults over 50. These people also should avoid taking large doses of vitamin C because vitamin C helps the body absorb iron. You do not want to take iron supplements if you have hepatitis C, unless you are specifically told to take iron by your provider.'

No diet has been shown to increase platelet counts or slow the progress of liver disease.
Platelets are produced in the bone marrow. They normally only live for just 5 to 9 days. So even if your bone marrow produced more platelets they would still be trapped in the larger spleen and destroyed anyway.

As I said previously, platelet counts are not a major issue for people with cirrhosis. If a person's cirrhosis is caused by a factor they can control then they should stop the thing that is injuring the liver. For example alcohol, toxic drug use, hepatitis B & C.

What is important for patients with cirrhosis it to not expose the liver to any toxins or other substances that can injure the liver and cause the liver disease to progress more rapidly.

A CT scan is not diagnostic of the stage of liver disease. A biopsy is the gold standard for diagnosing the grade of inflammation and the stage of fibrosis in the US. Liver biopsies are important for many reasons, such
as accurate diagnosis or ruling out any coexisting liver disease, staging
and grading the severity of liver disease, treatment decisions, patient and
provider reassurance, and as a benchmark for gauging future disease
progression.

The METAVIR system was developed by French researchers to score the severity of liver fibrosis associated with HCV

Stage 0 (F0) is indicative of no scar tissue.
Stage 1 (F1) describes mild fibrosis around the portal tracts.
Stage 2 (F2) indicates that the scar tissue is beginning to branch out from the portal tracts, forming a few septa.
Stage 3 (F3) indicates that the branches have extended to the point where the portal tracts begin to bridge, often known as bridging fibrosis, and numerous septa are observed.
Stage 4 (F4) describes the expansion of scar tissue to form thick bands in the liver, also characterized as cirrhosis.

I would suggest you talk to your hepatologist and have them explain want can be done to assess the degree of your liver disease and minimize your future liver damage.

Good luck to you!

Hector

[rpooo]

Wow Hector you sure have a wealth of information and I appreciate your help and concerns.

Here is what I know about vitamin C:
vitamin C is a powerful antioxidant and high doses of it may prevent free-radical mediated damage of the platelets.

It's not that vitamin C will increase platelets it protects them from being destroyed by free-radicals. As you stated vitamin C is known to promote the absorbtion of iron but even as a cirrhotic patient we need to maintain a healthy level. We can monitor this level with lab testing. Mine is a 68 with a normal range of 45-170. There are certainitly pros and cons to using this vitamin and should be only used if approved by your gastro or hepatologist.  In my case, having grade III varicies and a high risk of bleeding from low platelets, the Vitamin C I take has much more benefit than any risk of absorbing more iron.  Afterall, your body can only absorb the iron you put into it.  I try to maintain a health level of iron in my diet through food only and I don’t allow any through pills.  This has been working great so far, no bleeding and my iron is in range and towards the lower side.  

I really like your explaination of the METAVIR system. It will certainly clear up any confusion with diagnosis.

My diagnosis made with a CT scan clearly reveals cirrhosis. My treatment has been based on lab results and imagining. An invasive procedure (biopsy) seemed like an un-necessary risk. A patient with cirrhosis already has a compromised immmune system. I don't see how a biopsy would have changed my treatment options at this point. I must apologize for not having a better understanding of hepatitis induced cirrhosis vs. alcoholic cirrhosis. Since I wasn’t facing an any underlying diseases I didn’t need a biopsy.  It was clear as day why I got cirrhosis and that it was severe enough to give me a certain level of treatment.  Progression or not my lab testing and symptoms will tell me if I need a transplant. It is after all, the testing (blood work) that’s used to generate a MELD.  I could have a biopsy tell me that I’m getting worse but until my MELD gets to the right point they won’t give me a new liver. I think reasons for biopsy fall to the side under my circumstances.

I recently move from El Paso where I have been receiving treatment from a gastroenterologist. They were no Hematologists available but that is not the case here in Nashville. So I am excited to be able to get another professional opinion and perhaps better treatment options.

Thank you again Hector!

Randy

[orphanedhawk]

Hector makes a good point about iron. People with cirrhosis need to be careful to avoid iron. A good multi-vitamin without was recommended to me.
I found a food based one.
If you are going to take supplements, be sure to read the labels. Since our livers filter everything, some supplements are harder on us than others, simply because of the casing of the capsule. I used a vitamin D, which I could put on my skin, and was absorbed that way. Speaking of which, cirrhotics often have low vitamin D. You should get yours checked.
And do check the iron content of your vitamin C.

I'm assuming you meant there were good hepatologists, liver doctors in Nashville.

My understanding is cirrhosis doesn't differ whether its caused from alcohol of hepatitis. Hector can correct me on this, if I'm mistaken.

BTW: I never had a biopsy until after I had my transplant. The reason why is we already knew I had decompensated cirrhosis due to my ascites.

[HectorSF]

Hi Randy.

I wanted to mention the standard treatment to prevent variceal bleeding.
All quotes are from the AASLD Practice Guideline for for managing Varices.

'Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis'

http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/Prevention%20and%20Management%20of%20Gastro%20Varices%20and%20Hemorrhage.pdf

Recommendations

8. In patients with medium/large varices that have not bled but have a high risk of hemorrhage (Child B/C or variceal red wale markings on endoscopy),
nonselective
-blockers (propranolol or nadolol) or EVL may be recommended for the prevention of first variceal hemorrhage (Class I, Level A).

9. In patients with medium/large varices that have not bled and are not at the highest risk of hemorrhage (Child A patients and no red signs), nonselective
-blockers (propranolol, nadolol) are preferred and EVL (banding) should be considered in patients with contraindications or intolerance or non-compliance to
-blockers (Class I, Level A).

10. If a patient is placed on a nonselective
-blocker, it should be adjusted to the maximal tolerated dose; follow-up surveillance EGD is unnecessary. If a patient is treated with EVL, it should be repeated every 1-2 weeks until obliteration with the first surveillance EGD performed 1-3 months after
obliteration and then every 6-12 months to check for variceal recurrence (Class I, Level C).

11. Nitrates (either alone or in combination with
-blockers), shunt therapy, or sclerotherapy should not be used in the primary prophylaxis of variceal
hemorrhage (Class III, Level A).

What this is saying is that all patients with varices should be taking a beta-blocker to prevent the first bleed. It reduces the portal hypertension that we with scared livers have. Why is this important and basic treatment for all cirrhotics? Because once we bleed the chances of future bleeds goes way up. All pretransplant patients that I know use them. I have been taking Nadolol for 3-4 years now and have no bleeds. It is the only proven way to prevent bleeds other than banding which is the next thing to be done before bleeding. Bleeding from varices is a potentially life-threatening complication of cirrhosis. You can actually lose most of the body's blood during a bleed.

'Patients who survive an episode of acute variceal hemorrhage have a very high risk of rebleeding and death. The median rebleeding rate in untreated individuals is around 60% within 1-2 years of the index hemorrhage, with a
mortality of 33%.'

'Nonselective
-blockers have no role in the prevention of the development of esophagogastric varices but are the gold standard in the prevention of first variceal hemorrhage in patients with medium/large varices. Endoscopic variceal ligation (banding) has been established as an alternative to nonselective
-blockers for the prevention of initial variceal hemorrhage.'
----------------------------------------------------------------------------------
I am glad you are in Memphis where you will be able to see a hepatologist.
Methodist is where Steve Jobs had his liver transplant.

Maybe you can get a referral from your current doctor to have the transplant center do an evaluation so you know what options are available to you.

Methodist University Hospital Transplant Institute
1265 Union Ave.
Memphis, TN 38104

http://www.methodisthealth.org/healthcare-services/transplant-institute/organ-transplant-outpatient-clinic/

Transplant Outpatient Clinic

Pre-Transplant Evaluation

A good candidate for a transplant is determined by a full medical evaluation and input from several medical professionals. The transplant team performs this evaluation in the Pre-Clinic. This team is composed of the transplant surgeon, hepatologist/nephrologist, pre-coordinator nurse, financial case manager, and social worker.

Evaluation Process

The evaluation process begins with a referral from a potential candidate's primary care physician. The candidate then answers a variety of health and lifestyle questions. This information helps the transplant team decide the eligibility of the transplant candidate.

During an initial visit, a transplant candidate will meet with a financial coordinator and a social worker and receive detailed information about the transplant process. For those who are identified as potential candidates, a complete medical evaluation is performed. The medical evaluation is a series of tests dependent upon the specifics of each case. The surgeon reviews the results of this medical examination to further determine eligibility. If the evaluation indicates the candidate is appropriate for transplantation, staff members work with the patient to finalize financial arrangements.

The candidate will receive written confirmation and be listed with the United Network for Organ Sharing (UNOS), a non-profit scientific and educational organization that administers the only national patient waiting list. Once listed with UNOS, patient evaluations must be performed at regular intervals to determine continual eligibility for transplantation. Should an organ become available, it is offered to a patient on the list based on a defined set of criteria established by UNOS.
------------------------------------------------------------------------------------------
Local Support Group

Get the support you need with Living Kindly, monthly support group sponsored by Methodist Healthcare. The group is open to caregivers, family members, transplant candidates, donors and those who have had a transplant. You will have access to knowledgeable speakers discussing a variety of subjects, such as medication side effects, living donation, financial concerns, blood donation and maintaining a healthy lifestyle.

Methodist University Hospital Transplant Institute staff is on hand at each meeting to offer support, share their knowledge and answer any questions you might have. More importantly, other transplant donors and recipients are available to share their transplant experiences or provide mutual peer support to you and your family.

Not a joiner? That's okay. You are welcome to attend and listen. Living Kindly is designed to give donors and recipients access to as much information as possible to assist with their transplantation journey.

The group currently meets the second Thursday of each month in Stratton Auditorium, which is located at Methodist University Hospital (1265 Union Avenue). The class starts at 3:30 p.m., with a medication education session beginning at 3 p.m.

Food and beverages are served and parking is free.
-------------------------------------------------------------------------------
I would highly recommend you meet others who are waiting for transplants. It is a good way to learn a lot and you will see that many others are going through what you are going through.

Cheers!

Hector

[rpooo]

That my friend is some very good research. Thank you for all the time and effort you put in to that. I am currently using a beta blocker (Metoprolol) and it is keeping my blood pressure right around 105/58. I try to watch lifting heavy but you know how that can go.

I still have hopes of avoiding transplant but I know I need to be prepared just in case. I am actually here in Nashville only about 2 1/2 to 3 hours from Memphis which might give me an advantage someday. Vanderbilt is the transplant center here and I'll see my new general doctor the first part of July. It was recommended to me from two doctors I see a Gastro and Hepatologist here. My last gastro doc started telling me a year ago that approx. 5 years I will need a transplant but it’s been my goal to make him wrong.

So I just keep doing what’s been working for me. It’s good to hear from others and get their take on things that sometimes are easily forgotten, overlooked or simply just not known. I think our group is well on it’s way!

Thank you again for your very informative posting!

Randy

[HectorSF]

Vanderbilt sounds good. I am glad to hear you will connecting up with them soon.

I see you understand about beta blockers and lifting heavy weights. I use light dumbells and that seems to work for me as I want to be in shape when I have my transplant. The better for bouncing back after transplant surgery.

I am glad you are on top of this and being monitored. It has been a pleasure hearing about how you have been managing your liver disease, Randy. I wish everyone was as open and learning through their experience as you are. With your attitude I am sure things will look out for you. Attitude is so very important as we face the challenges of this disease. We can't control what our disease will do but we can choose how we interrupt it use it to help us carry on despite some scary things that can happen with this disease.

Be well.

Cheers!

Hector

[rpooo]

I felt this might be an interesting addition to this thread:

http://tinyurl.com/c6ywn6e

"Alcoholic Liver Disease May Not Lead to Cancer"

Patients with alcoholic cirrhosis have a lower risk of liver cancer than previously thought, Danish researchers found.

In a Danish registry study, 5-year risk of hepatocellular carcinoma among these patients was only 1%, Peter Jepsen, MD, PhD, of Aarhus University Hospital, and colleagues reported in the June 19 issue of the Annals of Internal Medicine.

And liver cancer contributed little to the high mortality seen in this population overall, as only 1.8% of deaths were related to the carcinoma, they found.

As a result, "hepatocellular carcinoma surveillance would be expected to have a minimal effect on mortality and is unlikely to be cost-effective," they wrote.

Patients with alcoholic cirrhosis are at higher risk for hepatocellular carcinoma than the general population, but the utility of liver cancer surveillance for these patients is unclear.

Jepsen and colleagues looked at data from a national registry on hepatocellular carcinoma among 8,482 Danish patients who'd been diagnosed with alcoholic cirrhosis between 1993 and 2005. Median follow-up was 4.1 years.

Over the study period, 169 patients developed hepatocellular carcinoma.

The researchers found that cumulative risk of the cancer increased steadily with time since the cirrhosis diagnosis, and was 1% at 5 years (95% CI 0.8% to 1.3%).

In sensitivity analyses that included all possible hepatocellular carcinoma diagnoses and a subpopulation of patients who were followed by hepatologists, the highest 5-year cancer risk was not much higher, at only 1.9%.

Cancer incidence was markedly higher for men than for women, they reported, and it rose with age.

Most of the patients who developed the cancer died (151 of 169), and 83.5% of these deaths were related to the cancer. The median survival time from diagnosis was 97 days for localized disease and 37 days for metastatic disease.

Overall mortality was high in the cohort, with 67.6% of patients dying during the study period.

In an assessment of cause-specific mortality through Jan. 1, 2009, the cumulative 5-year total mortality was 43.5%, while the 5-year risk for hepatocellular carcinoma death was only 0.8%, the researchers reported.

Thus, only 1.8% of all deaths were liver cancer-related -- a proportion that didn't change noticeably over time, they wrote.

"Hepatocellular carcinoma contributes little to their high mortality," Jepsen and colleagues wrote, noting that the results suggest cirrhosis patients would benefit only marginally from routine liver cancer surveillance, which falls below the country's accepted threshold for cost-effectiveness anyway.

They noted that the study was limited because diagnoses of cirrhosis and hepatocellular carcinoma were made by hospital physicians without uniform clinical criteria, and because the registry data lacked detailed information on patient care.

The journal listed the primary funding source as "none."

The researchers reported no conflicts of interest.

[Diana66]

I have been told ( I have not tried it yet) that Clorophyll will help raising platelets levels.
Also avoid garlic as it will increase the bleeding time

Personaly I can vouch for vit C, my platelets levels incresed during IV vit C, 30g/week in one infusion

I hope this helps

[rpooo]

Thank you Diana and welcome to our new group!

Vitamin C surely isn't for everyone with cirrhosis but in my personal  circumstance I think it fits pretty well. I didn't know that about garlic so I did some looking around and found this little artice:

Garlic, a pungent spice used to enliven many food dishes, has a long history of medicinal use to treat everything from the common cold to cancer. Garlic may also play a part in protecting against heart disease by its effect on platelets, irregularly shaped cell fragments that are the smallest of the blood cells, according to the University of Oklahoma Health Sciences Center. Platelets clump together at the site of injury to help stop bleeding. Taking garlic doesn't produce more platelets, but it does decrease platelet aggregation, the ability to stick together.

Read more: http://www.livestrong.com/article/528281-does-garlic-help-raise-platelet-count/#ixzz1zC88jLbN

Thank you for passing along the info, diet plays a huge role in our recovery so everything ingested should be carefully considered.

[crossroadsec]

Glad for the new forum. I've been a little lost dealing with bleedout and bandings since I finished triple. My platelets have not gotten above 70 since pre tx. Hopefully liver is regenerating and spleen will calm down and quit hoarding. haha!
Karen :)

[HectorSF]

Since this is a forum for all people with cirrhosis regardless the cause of their liver disease, it seems impudent to promote the use of Vitamin C (IV in particular) when a person with cirrhosis due to Hemochromatosis can be injured by its use.

What Is Hemochromatosis?

Hemochromatosis occurs when the body absorbs too much iron from foods (and other sources such as vitamins containing iron). This disease causes extra iron to gradually build up in the body's tissues and organs, a term called iron overload. If this iron buildup is untreated, it can, over many years, damage the body's organs.

Tips for Living Well with Hemochromatosis

There is much you can do to make sure your life is as normal and healthy as possible.

Check-ups: Have the amount of iron in your blood checked regularly.

Phlebotomy: Make sure to get phlebotomies when you need them.

Phlebotomy is the best treatment for hemochromatosis. Hemochromatosis cannot be treated by changing your diet alone.

Iron pills: Don't take iron pills, supplements, or multivitamin supplements that have iron in them. Eating foods that contain iron is fine.

Vitamin C: Vitamin C increases the amount of iron your body absorbs. Avoid taking pills with more than 500 mg of vitamin C per day. Eating foods with vitamin C (such as oranges) is fine.

http://www.cdc.gov/Features/Hemochromatosis/
----------------------------------------------------------------------------
Raising a person platelet count has no advantage for most cirrhotic patients. It doesn't improve their illness in any way. Besides platelet counts vary all the time as do all blood levels. The only time platelet count is a problem is when it goes lower than 20,000. Platelet count is caused by cirrhosis. Unless the cirrhosis is eliminated, platelet counts will always be below normal values.

Why cirrhotics have low platelet counts -

Blood flows from the spleen...through the portal vein...then through the liver.
Scar tissue in the liver (cirrhosis) can interfere with that blood flow, causing pressure to build up in the portal vein (portal hypertension), and the spleen to enlarge (splenomegaly).
As the spleen enlarges, it traps platelets. (The amount of platelets in the bloodstream is reduced because the spleen is busy trapping them).
So usually---people with cirrhosis end up having a problem with portal hypertension and an enlarged spleen, and a reduced platelet count in the bloodstream. As time goes by, the liver may try to repair itself by growing new cells. If there is a lot of scar tissue already present--- the new cells grow between scar tissue (and result in abnormal nodules). (The nodules and scar tissue can further interfere with blood flow through the liver). So over time people with advanced cirrhosis can end up having a problem with more and more abnormal nodules and scar tissue forming...which interferes even more with blood flow through the liver.....which makes the spleen continue to enlarge....and the platelet count continue to drop.


Hector

[rpooo]

New lab results taken 07/10/12 show a 20 point increase bringing my  platelet count to 80k from the 60k I was tested at on 03/28/10! I know this can change quickly in my next lab test yet still nice to see the difference I can make with diet.

My new doctor has sent the required information for evaluation by Vanderbilt transplant center. It's weird.. I hope to be accepted for reason of possibly better medical treatment and guidance yet I also hope not to be bad enough to be accepted.

I hope everything is going well on your end, Keep taking care!

Randy

[kirandhamal]

Hi,

My mother has just been diagnosed with HEP C & also with Liver cirrhosis.
I got shocked after getting this to know as I was not aware about these disease earlier.

I kept on getting the blood tests done as prescribed by doctors for my Mother.

After checking LFT doctor asked to get the Hepatitis checking done & she got detected with HEP C. After further diagnosis, she detected with Genotype 1 with the HCV viral Load of 220,351 & log value 5.34.

The treatment for Interferon & Ribavirin is so costly & therefore now I have taken her to Government Hospital for treatment. Now they have collected the blood for getting different tests done. I am waiting for the reports.

They have also conducted Liver Fibrosis test the result of which is Stiffness (KPa) 12.2 & some more details given on the report.

As of now she is not vomiting, getting a good sleep at night, due to tiredness she sleeps for sometime at day & again starts working as and when she feels comfortable.

Now I am really worried about her as I do not know at what stage her liver disease is & what is going to happen next.

Can anyone please comment with your expertise knowledge.

Regards,
Kiran

[rpooo]

I am not real familiar with Hepatitis since I have alcoholic cirrhosis. As you may already know there can be many causes for cirrhosis. I can tell you that I think the next step would be to diagnose what stage liver disease she has. This is done one of two ways, Ct Scan or Liver Biopsy, although biopsy seems to be the most common and accurate procedure used.
Here is a link to a video that can assist to educate you about said procedure:

http://youtu.be/ug3n7bvq2Wg

There are many different types of liver biopsies, such as the percutaneous, transjugular, laparoscopic, fine-needle aspiration and open surgery liver biopsy.

You should also know that symptoms of cirrhosis are normally not present until the person has reached decompensated cirrhosis. (End stage cirrhosis)
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What are the symptoms of hepatitis C?

Many people infected with hepatitis C have no symptoms. When symptoms are present, they can range from mild to severe. The most common early symptoms are mild fever, headache, muscle aches, fatigue, loss of appetite, nausea, vomiting and diarrhea. Later symptoms may include dark coffee-colored rather than dark yellow urine, clay-colored stools, abdominal pain, and yellowing of the skin and/or whites of the eyes (jaundice).
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How is hepatitis C treated?

There are no specific treatments for the symptoms of acute hepatitis C. Doctors recommend bed rest, preventing dehydration, a healthy diet and avoidance of alcoholic beverages. Most patients with mild to severe hepatitis C begin to feel better in two to three weeks and recover completely from their symptoms within four to eight weeks.

Synthetic forms of the protein interferon are used to treat some people with chronic hepatitis C. This can improve liver function in some people with hepatitis and diminishes symptoms, although it may cause side effects such as headache, fever and other flu-like symptoms. Sometimes this drug is used in combination with another drug, ribavirin. Treatment is effective in 10 percent to 40 percent of patients.

Many chronic carriers remain symptom free or develop only a mild condition, chronic persistent hepatitis. However, approximately 50 percent go on to develop the most serious complications of viral hepatitis: cirrhosis of the liver and liver cancer.

Keep posting as you find out more information, myself and others will do our best to communicate our experiences and knowledge. There is much to learn about the symptoms of cirrhosis and the best way to protect the liver from any increase cirrhotic advancement. Take care and I hope the best for you and your mom.

Randy

[Dee1956]

This is a great thread, thank you so much for all of your input
I did not know that garlic could thin the blood, I have been taking it

Thank you

[tguerre]

what do you know about taking folic acid for hep c/cirrhosis? Ive been in the hospital 8 times since 4/2012, for vomitting blood and bloody diarrhea. I end up getting blood transfusions and discharged with propranalol and vitamins,iron, folic acid. They banded first admission, but said the other admissions that the blood vessels were too small to band. Any ideas on folic acid and 1,000 units of irons daily ?

[rpooo]

Hello and Welcome to MedHelp!

I am very sorry to hear of everything you have been through lately. Unfortunately I don't know enough about your condition to really be able to help but after doing some research I came across a link that I think will help you gain some insight: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754513/

Also I know some others here that are much more familar than I. One of the main questions we always ask in this community is are you being treated at a transplant facility? Aso what stage of cirrhosis are you diagnosed?

I can also tell you that folic acid is often prescribed for cirrhotic indiviuals, the good side is that it helps accelerate the reproductions of liver cells although with that not all of the cells are healthy and so it increases the risk for Hepacellular carcinoma (liver cancer)

Iron supplements can also be dangerous too for cirrhotic patients so for someone with anemia and taking a supplement it will be critical to have your iron level carefully monitored.

I'll keep researching for you and I hope the article there will help too. I'm glad you found us and I sure hope we can offer some advice to have you feeling better. Take care.

Randy

[creewoman]

I have had platelet as low as 18, currently they are 22 thousand..For the last 14 years the highest they have been is38,and I could hardly believe it.Low platelets can be a problem with surgeries.I had my gall bladder removed with low platelets.My fear is a car accident.

[rpooo]

I'm glad to hear you are okay having your platelets be in that range yet I can sure understand your concern of a car accident. In general, platelet transfusion is not necessary, unless an individual with low platelets (less than 50,000) has an active bleeding or hemorrhage, or needs a surgery or other invasive procedures. Sometimes, transfusion may be recommended without any bleeding if the platelet count is less than 10,000. So there may be less to worry about than you thought.

Since I started this post my platelets have bounced back and forth from 60k to 80k so I think this is just going to be my normal for now.  

I came across one of your other posts and I'm sorry about your hospital stay, I hope you are doing much better. Have you had anything good to eat yet? Some of that homemade cheese you make might go over pretty good right now :) Take care and get well soon!

Randy

[yamadrigal323]

wow, you are giving me hope and not to panic anymore... i will share more about me later since i only beginning to grasp my condition, so i can share details with you... thank God for this thread... Yadira Angelini