Aa
Low Platelets and Biopsy Risk
What is the lower limit for the platelet count to safely do a bx? I suppose it is different under certain circumstances, but I mean to just compare against a Fibrosure that indicates no cirrhosis although platelets have been in the 90s and 80's for many years.
Ultrasound shows no portal hypertension (enlarged spleen would show that). Therefore portal hypertension the most common cause of a low platelet count in liver disease is not the cause.
"they've been that way for years (during my late 20's and 30's) and were "normal" for me" if that is true they have always been lower than norm something else is going on. I only know about liver disease so it is beyond me. But you should have a diagnosis as to what is causing it. From the hematologist. That is their job.
A lower than normal platelet count has no consequences and if you have had it for decades it is not something that is getting worse according to your docs. So it is nothing to worry about really. If would just like to know WHY they are lower than average, just for my own understanding.
As you where doing all your traveling you should have come to UCSF they would have worked you up and you would have a complete diagnosis of all health conditions. I feel lucky to have UCSF keeping me alive through all this. Especially the liver cancer over the last year. That got pretty touch and go for awhile there.
"what's the timetable on your new adventure?!? "
Which adventure? Oh you mean treatment stuff? Here are the milestones.
I have 2 more months of TB treatment.
Cancer surveillance 1st week of Sept.
Meet with my hepatologist last week of Sept. Confirm all plans.
Then I start clinical trial with GS-7077 & ribavirin.
Wait for transplant....
Transplant.
I start my second life.....
Don't forget to enjoy every day of your life. There are no guarantees. Every day of life is a gift even when we are in pain. I'd rather suffer and be alive then be dead and "at peace". There is an eternity of time for that for all of us. Challenges and suffering can lead to self knowledge, wisdom and dare I say... happiness. There is a saying in the cancer community... "Cancer is a gift". It is so true. For some people like myself, it has taken facing death to really know how precious everyday, routine, taken for granted life is.
Give yourself credit for taking on hep C now. Remember we are not our diseases, IQ, handicaps, career, house or car, hair color, eye color or skin color. We are human beings first and foremost. Just like everyone else. Everyday we have a choice of how we choose to manifest who we are in this world. For me that is plenty to be grateful for and enough to fight and live for.
Cheers!
Hector
"2003!!! Yow is it on a stone tablet? Kidding..."
Copies are on old purple mimeograph paper if you remember that far back, lol. (not really)
"Biopsy even 3-5 years when disease is progressing."
Duh, no kidding! But, I have only learned that this year. Yes, I have my conspiracy theories about that! I stupidly relied on annual physicals to take care of myself; year after, every doctor was aware of the HCV, the dropping platelets, and not one ever brought up anything about a new bx, ultrasound, or tx.
What a shock when this Feb my new primary physician thought new tests were needed asap. Ironically, she is the newest and youngest doctor I have ever seen and it was for something else. She was the catalyst to get me into tx this March.
"I probably asked you this but my mind is gone so I will ask again."
"Ever had an ultrasound recently?" Yes, in Feb ordered by the new young PP; it showed nothing.
"Do you have an enlarged spleen?" That was supposedly checked during the ultrasound and was not enlarged.
Is your liver nodular?" I don't know....how is that determined? No, if detected by an ultrasound. If determined by the Feb Fibrosure, nothing was said and I'll have to ask.
"AST higher than ALT?" My screening labs show AST 170 and ALT 203
"How does your doctor have an explanation for your lower than normal platelet count when not on treatment?" After reading many of your posts to others about low platelets as indications of the liver condition, I assumed it was the liver; I never discussed it with my trial doctor. But as I said, I plan to have this discussion with him 9/3, the day tx is over.
Only one PP, about 10 years ago, thought my immune system was destroying them, upon hearing that I called my old PP and he said they've been that way for years (during my late 20's and 30's) and were "normal" for me, not to worry. Last year another PP just wrote saying we needed to recheck them in three months. Other than that no one has said anything.
In 2003 I was simultaneously dx'd by a rheumatologist with fibromyalgia and HCV. All symptoms were attributed to fibro. (No comments on low platelets.) She refers me to a gastro, again all symptoms attributed to fibro, he sends me to a hematologist about platelets, neither the gastro or hema guy ever mention any correlation between low-ish platelets (100s) and liver status/HCV and don't have much concern about them. Granted, not that low, but what about them in conjunction with HCV??
Not buying into this trio of docs (and a 2nd opinion from another rheumatologist), nor into the fibromyalgia being so debilitating, I fly across the country to an internationally renowned medical facility to cut to the chase. All symptoms are attributed to fibro, low-ish platelets are of no concern (never even mentioned), bx is done and shows my liver in "pretty good" shape. Tx is not recommended as I am single, live alone and far from family (concerns for possible depression and no support) and the need to work as I am sole support of myself.
I went to a 2nd "world class" clinic...same, same.
Can't say I didn't try, but I guess you can say I was naive to trust and not start reading more. I tried, but didn't find much in 2003.
It seems to me that I've seen you post that platelets in the low 90s and HCV can indicate at least red flags with the liver and varices/banding should be a concern? Maybe I'm wrong on that being you, but my first awareness of the correlation of the two was on this site.
Oh my, I'm going to let it go for now. I can obsess, but I usually get weary of it and snap out of it quickly. I am sick of obsessing this past few days....no more for the new week. :) But I do appreciate your comments, and I would appreciate your words if you have anymore. I promise no more "buy why, but why..." like a three year old. LOL
So appreciate your knowledge. BTW, what's the timetable on your new adventure?!? Can't wait to follow your new journey! So exciting! FFH
Copies are on old purple mimeograph paper if you remember that far back, lol. (not really)
"Biopsy even 3-5 years when disease is progressing."
Duh, no kidding! But, I have only learned that this year. Yes, I have my conspiracy theories about that! I stupidly relied on annual physicals to take care of myself; year after, every doctor was aware of the HCV, the dropping platelets, and not one ever brought up anything about a new bx, ultrasound, or tx.
What a shock when this Feb my new primary physician thought new tests were needed asap. Ironically, she is the newest and youngest doctor I have ever seen and it was for something else. She was the catalyst to get me into tx this March.
"I probably asked you this but my mind is gone so I will ask again."
"Ever had an ultrasound recently?" Yes, in Feb ordered by the new young PP; it showed nothing.
"Do you have an enlarged spleen?" That was supposedly checked during the ultrasound and was not enlarged.
Is your liver nodular?" I don't know....how is that determined? No, if detected by an ultrasound. If determined by the Feb Fibrosure, nothing was said and I'll have to ask.
"AST higher than ALT?" My screening labs show AST 170 and ALT 203
"How does your doctor have an explanation for your lower than normal platelet count when not on treatment?" After reading many of your posts to others about low platelets as indications of the liver condition, I assumed it was the liver; I never discussed it with my trial doctor. But as I said, I plan to have this discussion with him 9/3, the day tx is over.
Only one PP, about 10 years ago, thought my immune system was destroying them, upon hearing that I called my old PP and he said they've been that way for years (during my late 20's and 30's) and were "normal" for me, not to worry. Last year another PP just wrote saying we needed to recheck them in three months. Other than that no one has said anything.
In 2003 I was simultaneously dx'd by a rheumatologist with fibromyalgia and HCV. All symptoms were attributed to fibro. (No comments on low platelets.) She refers me to a gastro, again all symptoms attributed to fibro, he sends me to a hematologist about platelets, neither the gastro or hema guy ever mention any correlation between low-ish platelets (100s) and liver status/HCV and don't have much concern about them. Granted, not that low, but what about them in conjunction with HCV??
Not buying into this trio of docs (and a 2nd opinion from another rheumatologist), nor into the fibromyalgia being so debilitating, I fly across the country to an internationally renowned medical facility to cut to the chase. All symptoms are attributed to fibro, low-ish platelets are of no concern (never even mentioned), bx is done and shows my liver in "pretty good" shape. Tx is not recommended as I am single, live alone and far from family (concerns for possible depression and no support) and the need to work as I am sole support of myself.
I went to a 2nd "world class" clinic...same, same.
Can't say I didn't try, but I guess you can say I was naive to trust and not start reading more. I tried, but didn't find much in 2003.
It seems to me that I've seen you post that platelets in the low 90s and HCV can indicate at least red flags with the liver and varices/banding should be a concern? Maybe I'm wrong on that being you, but my first awareness of the correlation of the two was on this site.
Oh my, I'm going to let it go for now. I can obsess, but I usually get weary of it and snap out of it quickly. I am sick of obsessing this past few days....no more for the new week. :) But I do appreciate your comments, and I would appreciate your words if you have anymore. I promise no more "buy why, but why..." like a three year old. LOL
So appreciate your knowledge. BTW, what's the timetable on your new adventure?!? Can't wait to follow your new journey! So exciting! FFH
2003!!! Yow is it on a stone tablet? Kidding...
Biopsy even 3-5 years when disease is progressing.
I probably asked you this but my mind is gone so I will ask again.
Ever had an ultrasound recently?
Do you have an enlarged spleen?
Is your liver nodular?
AST higher than ALT?
How does your doctor have an explanation for your lower than normal platelet count when not on treatment?
As far as platelet count for invasive procedures you have plenty of platelets. Can I borrow a few? haha All anesthesiologist check your blood level before a procedure. That how I found out I had cirrhosis in 2007.
So my journey started and continues to this day. "The long and winding road"...Now I know better than taking advice from a non specialist in the field. Grrr
Anyway where was I...... before I got lost in a HE fog belt...
Oh yeah... you're gonna be fine. Most of the stuff we worry about never happens anyway. Best to focus on the here and now. Don't forget to smell the roses! That's what's all about.
Ciao!
Hector
Biopsy even 3-5 years when disease is progressing.
I probably asked you this but my mind is gone so I will ask again.
Ever had an ultrasound recently?
Do you have an enlarged spleen?
Is your liver nodular?
AST higher than ALT?
How does your doctor have an explanation for your lower than normal platelet count when not on treatment?
As far as platelet count for invasive procedures you have plenty of platelets. Can I borrow a few? haha All anesthesiologist check your blood level before a procedure. That how I found out I had cirrhosis in 2007.
So my journey started and continues to this day. "The long and winding road"...Now I know better than taking advice from a non specialist in the field. Grrr
Anyway where was I...... before I got lost in a HE fog belt...
Oh yeah... you're gonna be fine. Most of the stuff we worry about never happens anyway. Best to focus on the here and now. Don't forget to smell the roses! That's what's all about.
Ciao!
Hector
Thanks Comrades,
I know they would never do a bx while in the 40-50's range during tx, but I'm thinking about after tx.
My last and only bx was in 2003 and my recent pre-tx Fibrosure said no cirrhosis; I'd like a more definitive bx.
My curiosity comes from a history of HCV for 40 years and platelets steadily declining over the last 20 years to 82. Although the last two year's drops were more dramatic than the previous years' slower steady pattern. Indication of cirrhosis or not? I want a bx! :) I think it a little odd, but there are so many scenarios that don't always fit. I'd be happy to stay in the 80's, but what if I don't and continue to slide?
I'm going to wait and see what the platelets do after tx, I'm also going to ask my doctor about the Fibrosure when I see him next (end of tx 9/3) and request a bx. Something tells me he will probably want me to wait a while. Without one I know I will always wonder about my liver status, cirrhosis, etc.
And if they continue to drop more rapidly after tx, with SVR? Well, that will be a whole new ball game.
As you said, Hector, they can do a transfusion if the bx were medically necessary, but "so far" I've never had signs of ascites/varices or hemangioma and my prothrombin time is good. (That is not to say that could not change quickly.) If they don't happen I just wanted to know how low I should let them go before I'd get turned down for my request. I don't think they'd give me a transfusion just because I was curious. :) I'll just have to wait and see how these numbers/symptoms stay or change as I go down the road.
Rather obsessive these last few weeks. :)
Thanks again for good info, FFH
I know they would never do a bx while in the 40-50's range during tx, but I'm thinking about after tx.
My last and only bx was in 2003 and my recent pre-tx Fibrosure said no cirrhosis; I'd like a more definitive bx.
My curiosity comes from a history of HCV for 40 years and platelets steadily declining over the last 20 years to 82. Although the last two year's drops were more dramatic than the previous years' slower steady pattern. Indication of cirrhosis or not? I want a bx! :) I think it a little odd, but there are so many scenarios that don't always fit. I'd be happy to stay in the 80's, but what if I don't and continue to slide?
I'm going to wait and see what the platelets do after tx, I'm also going to ask my doctor about the Fibrosure when I see him next (end of tx 9/3) and request a bx. Something tells me he will probably want me to wait a while. Without one I know I will always wonder about my liver status, cirrhosis, etc.
And if they continue to drop more rapidly after tx, with SVR? Well, that will be a whole new ball game.
As you said, Hector, they can do a transfusion if the bx were medically necessary, but "so far" I've never had signs of ascites/varices or hemangioma and my prothrombin time is good. (That is not to say that could not change quickly.) If they don't happen I just wanted to know how low I should let them go before I'd get turned down for my request. I don't think they'd give me a transfusion just because I was curious. :) I'll just have to wait and see how these numbers/symptoms stay or change as I go down the road.
Rather obsessive these last few weeks. :)
Thanks again for good info, FFH
Hi.
Contraindications to percutaneous liver biopsy -
Thrombocytopenia, platelet count less than 60,000
Increased prothrombin time, international normalized ratio (INR) greater
than 1.6
Ascites (transjugular route preferred)
Suspected hemangioma
Most doctor will have limits with which they are comfortable with. If a procedure is needed, a platelet transfusion can be given before the procedure.
Cheers!
Hector
Contraindications to percutaneous liver biopsy -
Thrombocytopenia, platelet count less than 60,000
Increased prothrombin time, international normalized ratio (INR) greater
than 1.6
Ascites (transjugular route preferred)
Suspected hemangioma
Most doctor will have limits with which they are comfortable with. If a procedure is needed, a platelet transfusion can be given before the procedure.
Cheers!
Hector
The link for the first post.
http://www.noblood.org/ask-professional/7118-liver-biopsy-low-platelet-count/
http://www.noblood.org/ask-professional/7118-liver-biopsy-low-platelet-count/
Since your already treating they wouldn't do a biopsy, your a geno 2 with very good odds of clearing so I'm not sure why you would even want to have one.
From what I understand around 60 would be a problem, mine were at 80 and I had no problems.
--------------
A per-cutaneous liver biopsy shouldn't be too hazardous with a platelet count of 88k. How prolonged are the clotting times?
if the INR is over 1.5, start her on vitamin K. DDAVP shortly before the biopsy might be a good idea. Direct pressure over the biopsy site would be important. Fibrin glue might be helpful if the biopsy was done laparoscopically, but electro-cautery would likely suffice.
Joseph T. Malak, MD
From what I understand around 60 would be a problem, mine were at 80 and I had no problems.
--------------
A per-cutaneous liver biopsy shouldn't be too hazardous with a platelet count of 88k. How prolonged are the clotting times?
if the INR is over 1.5, start her on vitamin K. DDAVP shortly before the biopsy might be a good idea. Direct pressure over the biopsy site would be important. Fibrin glue might be helpful if the biopsy was done laparoscopically, but electro-cautery would likely suffice.
Joseph T. Malak, MD
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