Low Platelets

[rpooo]

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

[nan535]

Wonderful and thorough response, Randy.

Nan

[rpooo]

Hello Kimmie and welcome to MedHelp.

I am sorry to hear about your husband’s condition. Bleeding varices are a symptom of advanced (Decompensated) cirrhosis. It is imperative he seeks treatment from a liver transplant hospital where he can be seen by a Hepatologist, any other doctor despite their good intentions just are not qualified to help him manage his cirrhosis. Here he will receive the best treatment available also it will be determined if transplant is an option or if it is needed. It is also important to find the cause of his cirrhosis and remove it to prevent further advancement. Here is what is going on:

Portal hypertension is an increase in the blood pressure within a system of veins called the portal venous system. Veins coming from the stomach, intestine, spleen, and pancreas merge into the portal vein, which then branches into smaller vessels and travels through the liver. If the vessels in the liver are blocked due to liver damage, blood cannot flow properly through the liver. As a result, high pressure in the portal system develops. This increased pressure in the portal vein may lead to the development of large, swollen veins (varices) within the esophagus, stomach, rectum, or umbilical area (belly button). Varices can rupture and bleed, resulting in potentially life-threatening complications.

How Is Portal Hypertension Treated?
Unfortunately, most causes of portal hypertension cannot be treated. Instead, treatment focuses on preventing or managing the complications, especially the bleeding from the varices. Diet, medications, endoscopic therapy, surgery, and radiology procedures all have a role in treating or preventing the complications. Other treatment depends on the severity of the symptoms and on how well your liver is functioning.
Treatment may include:
• Endoscopic therapy. This is usually the first line of treatment for variceal bleeding and consists of either banding or sclerotherapy. Banding is a procedure in which a gastroenterologist uses rubber bands to block off the blood vessel to stop bleeding. Sclerotherapy is occasionally used when banding cannot be used and is a procedure in which a blood-clotting solution is injected into the bleeding varices to stop bleeding.
• Medications. Nonselective beta blockers (nadolol or propranolol) may be prescribed alone or in combination with endoscopic therapy to reduce the pressure in varices and further reduce the risk of bleeding.

I hope this helps you out and I wish you the best. Please feel welcome to post anymore questions as you find out more.
Take care,

Randy

[nan535]

I suggest you start a new thread with your post. Then you will surely get more answers specific to your situation. Just scroll back up and click on post a question.

Nan

[Mkimmie123]

My husband was just diagnosed with cirrhosis this week, he began bleeding from his belly button profusely spent two days in the hospital was home one day and it happened again my house was covered in blood. They say surgery is to risky, what is going to happen will he bleed out at home, I am scared and do not understand this. Are they going to just keep sending him home for this to continue to happen again??? Some please help me understand

[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

[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

[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]

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

[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 ?

[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

[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

[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]

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

[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/
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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

[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 :)

[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.

[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]

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.

[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]

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

[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.

[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

[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