GI and low platelets

[dlerner]

Hello this question is for a G.I specialist! My father is 60 years old and is currently overdue for his routine colonoscopy. His gastroenterologist refuses to do it because he was recently diagnosed with splenomegaly which has decreased his platelet count between 30,000-45,000. He has been to a hematologist and had all tests run, it's not cancer or any known hematologic diseases, they are calling it idiopathic splenomegaly. Now my concern is that whenever he had colonoscopies in the past they always cut out polyps and they were always benign, but polyps can possibly become neoplastic. The gastroenterologist also says they can't do the colonoscopy in the hospital with a platelet infusion because there is no indication for it. I want to know if there is anything that can be done because I'm afraid it can eventually grow into cancer?

[patient915]

In my opinion, he should not get a splenectomy just so that he is able to get a colonoscopy.  Does he have a strong family history of colon cancer?  If not, I would refer to not having a colonoscopy as "taking his chances".  The risk of him getting colon cancer that could have been prevented that will cause problems before the end of his life is small.

[dlerner]

So basically it comes down to him getting a splenectomy to prevent his spleen from sequestering the platelets and finally being able to get a colonoscopy or he has to take his chances the way it is?

[patient915]

Yes all of what you said in your last sentence is true.  However, remember that he could undergo the conoloscopy and start bleeding so much that it won't stop and he dies.  Or he coud get a platelet infusion before the conoloscopy and he could have a bad reaction to the infusion and die.  There are positives and negatives to this situation, which makes it very tough.

[dlerner]

Thank you for the response, the last time he had his colonoscopy one of the polyps was very suspicious and luckily turned out benign. Can a documented history of suspicious polyps and his recent diagnosis of splenomegaly, age, and family history, lead to an indication for getting a platelet infusion.  I mean this can ultimately stretch out for years and he can develop Cancer and from a lack of colonoscopies it will be too late to help?

[patient915]

That's because there are risks to getting a platelet infusion.  Also, there is no current indication for a colonoscopy.  In his case, the risks of a colonoscopy outweigh the benefits.

[dlerner]

Thank you for the response, I did get a second opinion and they said unless the platelets are within normal they can't do the colonoscopy. My question is why he can't be treated as a high risk patient and get a colonoscopy in the hospital after having a platelet infusion?

[patient915]

Welcome to the gastroenterology community!  This is a case of benefits versus risks.  If he is not having any GI symptoms, then a colonoscopy could be put off, but there is always the risk of cancer (that possibly could have been prevented from an earlier colonoscopy).  However, you wouldn't want to run into any complications during the colonoscopy because of the low platelet count.  I would recommend getting a second opinion on this.