Platelets clumping ?

[Bali05]

Just got my wk56 bloods back and where I usually get a platelet count it reads:

Unable to report due to significant clumping.
Platelet estimate appears adequate.

Anybody ever heard of this in connection to tx ?
My platelets are usually mid to low 200s.
Last bloods wk53  platelets 214.


wk56 ,  UND < 5 IU

b

[susan400]

I don't know it's whatever one the trial site uses.  Susan400

[Bali05]

may be it was the lab not processing the blood sample correctly
I am currently using Quest which lab did you use ?

b

[susan400]

That's bizarre..., why?  Because I had that same exact result on my platelets test run on 06/22/2011!!   I was wondering about the same thing because I'd never seen that before on my platelets and now, you have the exact same thing happen to you??!!?   Weird.

Susan400

[Bali05]

Thanks L,
Indeed I retested and platelets were un-clumped again :-)
I just had so many CBCs over the last years and I never saw this before.

b

[mountainair]

All - nice discussion, Thanks

Me - geno 1 in the bocep anemia trial.  Like FIGuy, I had platelet clumping reported once - not significant - all the prior and post labs were measurable.

L

[GoofyDad]

For another anecdote - my hepa at CPMC says they don't fully understand the low-platelet causes (thrombopetunia or whatever). He says he sometimes sees platelets remain low in people into whom they've installed brand new shiney livers - and they don't know why.    

[willing]

good hypothesis however a very common response based on posted CBCs sems to be that platelets can get hammered during tx even with full rbv dosing.

An interesting comparison would be your neutrophil drop as a percentage of base. RBCs get pounded by both ifn and rbv so they're not a good comparison point but if the ifn suppression of platelets is being rescued by rbv, you should see a greater percentage drop in your neutrophil counts.

Anecdotally, it seems those reporting the worst platelet drop issues are those who can least afford them - ie where the ifn -triggered reduction is added to suppression triggered by advanced fibrosis.

[Bali05]

INF typically causes thrombocytopenia  (decline of platelet count )
Ribavirin typically causes thrombocytosis  (increase of platelets)

My guess is one suppresses platelet production and the other stimulates it.

This becomes very apparent when those meds are taken separately.
Like people who only took INF in the past had much more low platelet problems

With combo therapy this can balance itself out , as it is in my case. I am on wk58
and still have pre tx platelets .

My guess is it depends on the amount of liver damage on how the platelet
situation balances out individually with Peg and Rib.

b

[willing]

thanks - I had wondered what caused my pre-ifn  platelet spike. The abstract includes  no discussion of a likely cause and the average increase observed wasn't very big (24/uL) but it was significant (0.001) for the sample size.

Apart from boosting ifn effect, this could be another reason for those with low platelets (typically F3s and above)  to consider rbv priming.

[Bali05]

Ribavirin priming increases platelet count.
http://www.hivandhepatitis.com/2010_conference/aasld/docs/1214_2010_a.html
Also Dr. Melissa Palmer writes about it. Not a big fan of hers but she got that one right.

From what you are describing russian roulette and all I guess I am doing pretty good.

b
wk58 :-)

[willing]

Have not heard of  rbv as a platelet booster. If you have any refs on  rbv-triggered platelet increase please post - this is  a common problem around here.

I can definitely understand the reasoning behind your extension but would probably not make the same decision. After seeing loads of post-tx posts along the lines of DD's I  approach each ifn shot (like today's) with the  enthusiasm  of facing  another round of russian roulette. Adding  24 more shots to get an 22-14=8% reduction in relapse odds seems like taking on  more risk of another kind, but a lot depends on age/sx etc.

[Bali05]

Increase in platelet count during Riba preloading is an advantegous
sx of Riba. It is called Thrombocytosis . Once you add INF it usually gets offset again
because INF lowers platelets. My platelets went up to 293 during preload than straight
back to where they were with first INF shots.Still today if I increase Riba platelets
go up slightly.

Data for geno 4s is always skimpy. BTW that is another reason why I keep going the extra mile
when given a choice. Overall several studies show improved SVR with extending tx starting
with Sanchez Tapias. I see it like higher Riba dose produces better SVR rates.
I do not follow just one study but more the overall trend and direction in my decision
making.
Extending from 48 to 60 might just give me an extra 5% and it is always the same question.
What if I am one of the 5% ?

b

[willing]

>Guess you are hallucinating a bit....
OK, that does it, time to lay off the Lonestar cooler for a while.

Interesting study (also here)
http://www.ncbi.nlm.nih.gov/pubmed/19909752
which contradicts earlier work that showed  no benefit to extending among cEVRs.

From Table 2 of the paper, it looks like G4 representation was skimpy (only 10 patients in the 48w (group A) and 11 in 72w (group B) with very similar relapse rates 4/10 in A and 4/11 in B). More motivating,  given your very good VL drop, is that even among cEVRs (they used und50 at w12) the extra time lowered relapse rate from 22% to 14%.

your platelet count  looks great. Mine, which had been hovering at low normal prior to tx, spiked to 200 during preloading (why?)   but  then started dropping continuously. Down to 100 a moth or so ago., I'll find out in a couple of days what additional damage the vic is contributing.

[Bali05]

Thanks Bill,
Unfortunately Tela and Boc are not an option for a geno 4.
In a way 4s now have become hardest to tx .

When did you become UND by what sensitivity PCR on your previous tx ?

Cheers
b

[Bill1028]

Bali, I went 48 weeks (44 of boc).  



I also tapered off from 72 weeks to 76 weeks and it didn't work.  If I were to it that again, I would stay on full dose.  My doc said there is no basis for it but he let me do it anyway.  If you are doing okay on treatment keep going.  Good luck!

[Bali05]

Guess you are hallucinating a bit....
I am principally following Dr. Douglas Dietrich`s protocol for non RVR
geno 1 / 4 which is 48wks of tx AFTER true UND by sensitive TMA is
achieved. In my case that was documented @ wk10 +48wks = 58wks.

There is quite a bit of evidence that extending for slower responding non-RVR geno 1/4 can lower relapse. Not by very much but if you are in good shape otherwise than why not go for it especially when you are geno 4 without PI option.

http://www.clinicaloptions.com/Hepatitis/Journal%20Options/Collections/2010%20JO%20Hepatitis%20Volume%204/Articles/Ferenci_Gastroenterology_2010/Slideset.aspx

[willing]

for a while it seemed your posts were signed with  a tag along the lines "week 49 out of  55" or such - but maybe I was just hallucinating (again).

That's the only way I  keep track of passing time these days.  I couldn't tell you the date but I know, to the hour,  that I am on day 6 of week 32 of 48.

Anyway, all the best with your w60 meeting.

[Bali05]

What on earth are you talking about ?

[willing]

I was wondering why you had stopped using the "x out of y" tag. So like voyager  you're drifting farther into the unexplored interstellar dust.. good luck on coming home soon!

[Bali05]

good sign Goofy

thanks

[GoofyDad]

( Mike and Goofy, I think).  

My recollection of this is fleeting and vague - as it is for so many things, like what I had for breakfast for example. But I think FLguy is right, and I'm here to tell about it, to the extent that I can remember. So all in all, a good sign, no?

[Bali05]

thanks

[Bali05]

First of all huge Congrats to your SVR !!!!!!!!!!!!!!!!!!!!

"How long are you treating"
That`s a good question. I could have easily stopped already but I am geno 4 with no
PI to fall back on in case of relapse. There is a number of studies that show reduced
relapse rate with extended tx so I am currently just maxing it out general health and
insurance coverage permitting.
Next meeting with my Hepa is wk60
At wk48 he gave me 85-90% SVR.
I will decide @ the meeting , also going to taper INF after that.

b

[Bill1028]

I had it several times, it could be that your blood sample was mishandled.  Not to worry.  

How long are you treating?