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Decreased Platlets=Liver Disease?
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Decreased Platlets=Liver Disease?

I recently had blood work done and it indicated that my Platelet count has dropped to 126,000.  I have always had my blood checked at least annually and my platelets have always been in normal range.  I wonder if this indicates that I am now cirrhotic or getting there?  Has anyone ever heard of dcereased paltelets in the Hep C patient inidcating anything other than this?  Your help is appreciated.
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446474_tn?1404424777
Hello!

126,000 is only slightly low. A mild case of Thrombocytopenia.
(I have cirrhosis and an enlarged spleen so my platelet count is usually around 70,000. Three weels after stopping treatment my count is 32,000. I went down to 26,000 during my 12th week of treatment. Low plate count was the first indication that I had cirrhosis).

Do you take asprin on a regular basis?
What does your last biopsy say about the condition of your liver?
Stage? Grade?

Here are more details about Thrombocytopenia....

GRADING OF THROMBOCYTOPENIA
Normal: 150,000 to 400,000 platelets/mm3
Mild: 50,000 to 150,000 platelets/mm3
Moderate: 25,000 to 50,000 platelets/mm3
Severe:  Pregnancy, which may cause mild thrombocytopenia.
> Idiopathic thrombocytopenic purpura (ITP), a condition in which your immune system mistakenly identifies platelets as a threat and forms antibodies that attack them.
> Other autoimmune diseases, such as lupus or rheumatoid arthritis, which may lead to destruction of platelets due to a malfunctioning immune system.
> Blood poisoning from severe bacterial infections (bacteremia), which may lead to destruction of platelets.
> Thrombotic thrombocytopenic purpura (TTP), a rare, life-threatening condition that occurs when small blood clots suddenly form throughout your body, using up large numbers of platelets. TTP sometimes happens as a result of a genetic deficiency, but more often the cause is unknown. In some cases, it may be associated with infection or a chronic illness.
> Hemolytic uremic syndrome, another rare disorder that causes a sharp drop in platelets, destruction of red blood cells and impairment of kidney function. Sometimes, this can occur in association with a bacterial Escherichia coli (E. coli) infection, such as may be acquired from eating raw or undercooked meat (often hamburger).

Certain medications can cause a thrombocytopenic reaction by confusing the immune system and causing it to destroy platelets. Examples include aspirin, heparin, quinidine, quinine, sulfa-containing antibiotics, some oral diabetes drugs, gold salts and rifampin.
In some cases, heparin-induced thrombocytopenia can cause excessive blood clotting instead of bleeding, increasing the risk of clot formation deep within a leg blood vessel or the transport of such a clot to your lungs, which can be life-threatening.

Trapping of platelets in the spleen
The spleen is a small organ about the size of your fist located just below your rib cage on the left side of your abdomen. Normally, your spleen works to fight infection and filter unwanted material from your blood. An enlarged spleen — which can be caused by a number of disorders (including cirrhosis) — may harbor too many platelets, causing a decrease in the number of platelets in circulation.

Screening and diagnosis
Mild thrombocytopenia often causes no signs or symptoms. A routine blood test may show that your platelet count is low even though you haven't been experiencing problems. If you have a condition that puts you at risk of thrombocytopenia, your doctor may monitor your platelet count to make sure it doesn't fall too low.

If you've noticed possible signs and symptoms of thrombocytopenia, such as easy bruising or excessive bleeding, your doctor will likely obtain a platelet count from a blood test and examine a sample of your blood under a microscope. Your doctor may also order special blood tests and a bone marrow examination to help determine the cause.
As a first step toward treatment, your doctor will want to identify the underlying cause of thrombocytopenia. If you have a fever in addition to a low platelet count, this may indicate you have an infection. A physical examination may reveal an enlarged spleen that may be entrapping platelets.

Complications
Mild thrombocytopenia typically has no long-lasting effects. The biggest risk of severe thrombocytopenia is bleeding into the brain or digestive tract, which although rare, can be life-threatening. Complications more often arise from the conditions that cause thrombocytopenia. For example, the kidney failure that accompanies hemolytic uremic syndrome may require lifelong treatment if damage to the kidneys is permanent.

Treatment
Sometimes, treatment for thrombocytopenia isn't necessary, particularly in children. In these cases, the bone marrow may make up for the shortage of platelets by producing large numbers of new ones until the initiating cause subsides. Young platelets are especially active in clotting, so even though the total concentration of platelets is low, your child may not experience any bleeding problems and need no special treatment.
Mild thrombocytopenia in pregnant women usually improves soon after childbirth.
If your doctor can identify the cause of thrombocytopenia, then the approach is to treat the underlying condition or stop using the problem medication.
Treating thrombocytopenia may involve several options:
>Medications. For idiopathic thrombocytopenic purpura, treatment may include medications that block the antibodies that attack platelets, such as corticosteroids. Intravenous immunoglobulin may be used when rapid elevation of your platelet count is needed. If corticosteroids don't help, your doctor may recommend medications that suppress your immune system to reduce antibody formation, such as cyclophosphamide (Cytoxan) or azathioprine (Imuran).
> Surgery. Sometimes, removing the spleen (splenectomy) relieves signs and symptoms or helps improve chronic idiopathic thrombocytopenic purpura that doesn't respond to corticosteroids.
> Blood transfusions and plasma exchange. For severe bleeding, your doctor can replace lost blood with transfusions of packed red blood cells. Platelet concentrates are given to treat severe thrombocytopenia, particularly those related to cancer or chemotherapy.

Thrombotic thrombocytopenic purpura requires emergency treatment with plasma exchange therapy or therapeutic plasmapheresis. If you have hemolytic uremic syndrome, you may need kidney dialysis in addition to red blood cell and platelet transfusions.

Self-care
If your platelet count is low, your doctor may recommend avoiding drugs such as aspirin, which may impair platelet function, and avoiding excessive alcohol intake. You may also wish to avoid contact sports, which can put you at a higher risk of injury and bleeding.

Hope this helps.
Hector

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Avatar_m_tn
Thank you so much for your very helpful reply.  I do take aspirin daily (325 mg) as I am 55 yo.  I have had Hep C for probably 39 years (got dx'd in the non-A non-B days).  My ALT and AST are normal and have been for many years, althouth they werre elevated slightly in the 70s and 80s.  I do know that I can stilll have cirrhosis even with normal Liver functions.  My billirubin is normal too.  I had noticed that my platelet count was at the lower end of normal in February.  However, a varicose vein openned in my leg requiring a visit to the ER recently.  The doc there wondnered why I took a fairly long time to clot, so he ordered the lab tests that revealed the mildy lowered platelet count I mentioned

I have an appt. with my GI doc next month to discuss the possiblity of getting TX.  I have shyed away from it for many years and hope that I haven't waited too long.  I know that lowerd platelets may be an indication of cirrhosis, but I am still rooting for the aspirin being the culprit.  Do you think I should avoid aspirin?  Did you say you have started tx?  If so , how is it going?  What stage of liver disease do you have, if I may ask?  Thanks again for you help.

Harry
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446474_tn?1404424777
Harry.
(I'm replying to both of your posts).

I'm same age and years with HCV as you. But I also have HBV. Co-infection is supposed to speed up liver damage.

I started treatment 3 1/2 months ago. Went through 13 weeks. I did not respond to treatment. "null responder" Interferon does not kill the virus in my body. So stopped treatment. I am Stage 4 cirrhosis with enlarged spleen and portal hypertension. The whole shabang!

I would talk to your doctor about the aspirin, as I don't have experience with that.
I'm sure you are aware that large amount of aspirin and other meds can severely damage your liver?

Did you ever have a biopsy of your liver?

Short of a biopsy, maybe you can try to predict your chances of having cirrhosis?

HALT-C Formula for Predicting Cirrhosis
http://www.haltctrial.org/cirrhosis.html

Our predictive model relies on a few standard laboratory values that are routinely available in patients with hepatitis C - platelet count, AST/ALT ratio and INR.
The regression formula for predicting odds of having cirrhosis is as follows:
log odds (predicting cirrhosis) =
-5.56 - 0.0089 x platelet (x103/mm3) + 1.26 x AST/ALT ratio + 5.27 x INR.
The formula to calculate predicted probability is exp(logodds)/(1+exp(logodds)).

Our model performed well in the objective of predicting histological cirrhosis in our population of >1,100 well-characterized patients with chronic hepatitis C and advanced fibrosis. A cutoff predicted value of 0.5 to identify patients with cirrhosis, would misclassify 14.8% (70/474) of noncirrhotics (positive predictive value of 75%). Approximately half, 48.5%, of the patients fell between the two cutoff values and would not be classified accurately. A cutoff of 0.6 would lead to misclassification as cirrhotic in 8.0% (38/474) of noncirrhotics, but would increase the proportion of patients that would not be classifiable to 59.3%.

The ranges used in our analysis are as follows:
Platelets 39-442
INR 0.8 - 1.6
AST 18 - 789
ALT 15 - 772

This may help.
Hector
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Avatar_m_tn
Thank you for your helpful reply.  I will go to that site and see if i can figure out how to do the formula.  I have not had a biopsy.  I am a bit concerned about doing one, but now may have to be the time if I am to consider Tx.  I am not infected with hep B, but I am overweight.  Also have a Hx of EtOH years ago.  Anyway,  I guess one day and one test and one appt at a time.  Thanks again Hector.

Harry
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446474_tn?1404424777
Harry, remember a biopsy is "the gold standard" for determining the status of your liver. It is really a very simple and relatively painless procedure. There was a recent thread about the biopsy procedure that you may want to read to get peoples different points of view as far as their experiences are concerned.

The information a biopsy can give you is invaluable as far as knowing IF and WHEN you should treat. It tells you where you are in the progression of you liver disease, which is caused by HCV. For me it really gives me peace of mind knowing where I stand. Even having cirrhosis. I know what symptoms to look for as my disease progresses further. So I am much better able to monitor my own health from what I learned from my biopsy.

For you, you want to know what Stage you are at so you will know if you need to treat or if you can wait for newer more effective treatments to be available.

Harry, please don't wait until you are Stage 4 like me. You future options become a lot more limited once you become cirrhotic.

Best of luck with you doctor visit. Let us know what happens.
Hector
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Avatar_m_tn
The problem with  aspirin is the risk of bleeding. With risk of cirrhosis and complication which come along with it you do not want to risk bleeding from an internal source.
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Avatar_m_tn
Thanks so much Hector.  I will probably opt for a Biopsy so, as you put it, I will know where I stand and how far along I am.  I know I have a pretty high Viral load, i think over 5 million copies.  I think my strain is 2B if memory serves me well.  I will let you know how my doc visit goes on July 18.  Thanks again for all of your help.
Harry
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