Platelets and bilirubin levels

Curious how can bilirubin levels be normal when platelet levels are to low. If platelets are low because of cirrhosis shouldn't bilirubin levels be high because of cirrhosis?

If both show liver is dysfunctional it would only seem normal to me that they should both show liver damage.
My  bilirubin levels have always been normal while platelets are always low. Anyone else notice this?




I guess my question is how can one be normal and the other not?

[HectorSF]

A low platelet count can be a sign of early cirrhosis.

Scar tissue in the liver (cirrhosis) can interfere with that blood flow between the spleen and through the portal vein then through the liver 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. The spleen traps 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.

Do you have portal hypertension and an enlarged spleen?
If this is the only complications a patient with liver disease has then they would be considered to have "Grade A"  cirrhosis (compensated) according to the Child-Turcotte-Pugh scoring system. As more complications arise it indications the disease has progressed further and the liver is more damaged.

Liver disease is a progressive disease. There are various degrees of injury to the liver over time. Complications from liver disease do not appear all at once but over time. A low platelet count (<125,000) is usually one of the first signs of cirrhosis. As the liver gets damaged more other complications occur until the liver ends up failing to be able to perform enough functions to keep the patient alive.

As the disease progresses more blood values will become more abnormal and physical chances to the body will become worse.

Bilirubin is a component of the bile secreted by the liver and its concentration in the blood is a general indicator of the liver's functioning. The liver helps break down bilirubin so that it can be removed by the body in the stool. When the liver becomes so damaged that it can't perform all of it functions (decompensated cirrhosis) the bilirubin levels tend to build up in the body.

Jaundice may be noticeable in the white of the eyes at levels of about 2 to 3 mg/dL (34 to 51 μmol/L),[12] and in the skin at higher levels.
One of these changes is higher bilirubin so eventually a patients skin turns "Bart Simpson yellow".

Please refer to the Child-Turcotte-Pugh scoring system to assess liver disease severity based on progressive complications and symptoms.

Encephalopathy (grade)
Ascites - None - Mild (or controlled by diuretics) - At least moderate despite diuretic treatment
Prothrombin time (seconds prolonged) -  6
INR -  2.3
Albumin (g per dL) - > 3.5 - 2.8 to 3.5 - < 2.8
Bilirubin (mg per dL) -  3

A score of 5 to 6 = grade A; 7 to 9 = grade B; 10 to 15 = grade C cirrhosis.

Cheers!
Hector

[streamline569]

That is exactly what I have is grade A child cirrhosis. MRI doesn't really show portal hypertension, it is questionable, as of my last discussion with my doctor as I am trying to find out just how much damage I really have. My doctor has been doing endoscopy procedures every 6 months and he said he has never seen any Ascites. I do have an enlarged spleen, of course that's were all my platelets are. Sorry about being so anal about all this. I'm trying to figure out just how bad my liver damage is, again going back to my obsessiveness about whether to treat for 24 weeks or 48 weeks.

I find my platelets to be low for someone like me who is grade A cirrhosis. It seems my platelets should be higher then 60 where they have been the last few years. I do have Thalassemia traits but doctors know so little about it as it is not major and was found accidentally as an adult. I always wonder how much of the low platelets and enlarged spleen is related to the Anemia as in 1990 an enlarged spleen was found but I never followed up with it knowing at that point I had the Thalassemia and I knew that was one of the sign of Thalassemia.

Now I regret not knowing to  have asked for copies of blood reports. I would find it interesting to see what my blood reading have been over the years.

Thank for you answer, just me being obsessive. I need to control that.

[HectorSF]

A few minor points.

If you have cirrhosis of any degree you should treat for 48 weeks. Patients with cirrhosis have lower rates of SVR because of the advanced liver disease. To treat for 24 weeks and have a relapse will make it more difficult to retreat in the future. To risk failing treatment when one is cirrhotic is in most medical people's opinion and mine is a very poor choice. You could be risking never being able to treatment again which would mean your only option is a liver transplant and all that entails including the shortening of your life expectancy. Basically I would can it a no-brainer.

An endoscopy (EGD) looks for varices and the size of varices so that prophylactic treatment can be applied before bleeding occurs.

How low platelets counts are in cirrhotics varies in different individuals. I also had about 60,000 when I was grads A before decompensating. Platelet count doesn't correspond to how diseased the liver is per se. It depends on a number of factors.

Regarding Thalassemia I have no experience or knowledge of the illness and its ramifications. I would have a Hematologist look at it.

Good luck with your treatment.
Hector

[working dog]

that was great info....thanks...btw a friend of mine had a friend that went to live in fl for a while to get a liver transplant...he says theres lots more livers down there from motorcycle accidents...he did go down there and i think 3 months later got a transplant....i don't know what to think about this....billy

[eureka254]

I agree with Hector wholeheartedly: as a cirrhotic, 24/48 should not be up for debate, unless you're not tolerating treatment.  His summary of the variables of cirrhosis is very accurate -- platelet levels are a usually a result of spleen-associated complications that can come along as collateral damage with cirrhosis -- however, it's important to remember what one cirrhotic has as a complication does not translate to that of another, and splenic sequestration of platelets can rise and fall.

Also, the liver has so many different functions, the variability of symptoms can come and go.  As example, my husband's platelets got as low as 38 during treatment, but his bilirubin levels were all normal.  Currently, with class B cirrhosis and HCC, he has normal platelets, but elevated bilirubin.  The functions of the liver and the subsequent responses in the body are neither linear nor lateral.

In regards to the thalessemia, that is a separate organ system function related to blood cell production.  Thal minor is an inherited trait, and often times isn't diagnosed in women until pregnancy -- most people who have thal minor do not have any obvious symptoms.  Thal trait simply means you have a larger amount of a different hemoglobin variant in your red blood cells (not a large amount, less than 10%), so you might tend be slightly 'anemic' -- since anemia is not infrequent in pre-menopausal women, having thal minor often goes unnoticed in women. It just means that you have a smaller than average mean red blood cell volume because of the cells your bone marrow makes, but it's such a small difference to usually not cause serious issues.  Might make you more prone to anemic symptoms than others treating, but having thal minor should not impact your liver disease or treatment significantly.  Hope that helps some. ~eureka

[streamline569]

Thank you for all the excellent information. Very informative. I know the 48 weeks is the better choice, but they also say cirrhotics have to be watched very carefully when treating the extra weeks and they also say they MAY benefit, they still don't have the data to show that cirrhotics will definitely benefit as far as I've been reading. They just didn't have enough cirrhotics  in the trials.

A decision  will have to be made soon. I still have a higher success rate then if I had treated with regular SOC before the PI came out. I think for me it will depend on my labs and how  I'm feeling, if platelets and hgb stay stable and then there is still the factor if insurance will approve another 6 months as of now I'm only approved for the 24 weeks.

It's just a decision I want to make now. It will make the next 12 weeks harder if I know I still have another 6 months after the 12 weeks. So I'll just take it one week at a time right now.

Thank you again

[streamline569]

Oh another point. I was reading today on the new clinical news letter they send to us that they are starting to recommend the 48 weeks for don't quote me I don't have the info in front of me but I think it was for F0 to F3. Where and when does it all stop and when are the anti virals enough to stop the virus. Wasn't the whole point of PI to treat and clear in less time?

[can-do-man]

Being that i am cirrhotic also i treated with SOC for over 72 weeks and relapsed 1 month post tx. I then retreated with VIC in their last trial, got lucky and was in the 48 week arm, now i'm SVR.

To me the whole point of the PI was to give me the boost i needed to gain SVR and it did, there are many that are able to treat for less time then SOC only and win.......... Being cured is the main thing i believe.

Your cirrhotic, do you feel time is on your side to treat less and roll the dice? For me i knew this was maybe my best last chance and there was no cutting corners, if i had failed at least i wouldn't be second guessing the what ifs while my live contiuned to be under attack with no further options, at least for the time being.

Best to you on what you decide.

[streamline569]

According to the prescribing information, treatment-naive patients with cirrhosis may benefit from 36 weeks of pegIFN/RBV after completing triple therapy, even if they meet the criteria for eRVR. In other words, one may not want to follow the RGT paradigm for this subset of patients, but such decisions should be individualized and should be based on their tolerability and adverse events. However, for patients without cirrhosis who are rapid responders, the entire treatment duration is 24 weeks.

[streamline569]

The percentage I think from what I was reading is 78% 12/24 and 98% 12/48 for someone who has been undectable at 4 and 12 weeks. With a CC I still think that is helping me now with the peg and I just can't see butting more of this poison in my body if it is effecting my health. 70 or 78% is great odds compared to what damage another 6 months may do. I guess it an individual decision  one I haven't made yet. For you I bet you are  a TT and SOC would never have work for you. I am so happy you have finally made SVR

[eureka254]

The goal is to set yourself up for the best outcome possible; with cirrhosis, the down-side of relapse is that it may leave you without the luxury of being able to weigh your options in the future.

No doubt, certain things take precedence: how your body holds up beyond the 24 and whether your insurance okay's it may make the decision for you, but my guess is you don't want to be obsessing later in the event of relapse 'what if'...

My husband got to the 48 weeks, was advised to do the 72 (with SOC), and actually decided to do more, and finally ceased therapy when anemia was not amenable to procrit even twice a week.  He may not have needed to do the extra weeks, but there's a certain amount of comfort in knowing you've done everything you possibly can to prevent the return of the virus and related damage.  

Good luck whatever happens and whatever you decide.