low platelets

I am on week 5 of double dose peg and reba treatment My platelets  count showed at 60 WBC and RBC down as well. My doctor told me that if my platelets god down any further they will have to reduce my TX to a single dose until my platelets go up. I have treated before on single dose plus Riba for 48 weeks.and the Hep C came back I believe my best chances of SVR are double dose Peg with Riba until UND period then balance of single dose until 72 weeks are completed. I do not want to reduce my dose now took  2 years ago as a rescue drug.I need answers on how to bring up my platelets. God bless you all

[HectorSF]

Sorry to here about your response to treatment. It is all too common.

You say you were treated before. Did you have a similiar experience? The meds will drop those platelets and WBC and RBC. Unfortunately there is no drug I am aware of that will bring up your platelets. Although I think I recall a few people saying they had blood transfusions? But for another 60+ weeks? That would be pretty rough. Do you have to treat now?

Maybe your levels will moderate. I know mine varied a lot during treatment but then started heading "south" for good. I started losing the platelet battle around week 12. I was down to 26k. My doctors didn't want to see me go below 25k.

Best of luck.
I hope you find a way to continue therapy.
I'm sure other will have more helpful info and ideas.

Hector

[nannyleenie]

the post from nannyleenie about low platelets is actually myself,redeemed 1,i must have posted under nannyleenies screen name,she is my wife.my first time on tx 2 years ago,rbc went down so i needed to take procrit,i dont believe i had an emergency situation with my platlets,as i finished 48 wks of tx.im taking double shot of peg until und.,so maybe that is kicking down the platelets.they went from wk. 1 at 72,to 7o at wk. 2,to 80 at wk. 3 to 60 at last labs at wk.4.how far down can they go for me to be in danger of internal bleeding and reduction of tx. to single dose.appreciate any inpute and i hpoe all is well with you,god bless

[HectorSF]

Hi!

Thanks for the additional info.
Between 50k and 25k was the range that my docs started to be concerned. Note that different Docs have different reference points. Some people here on the forum have been told to stop treatment at much higher levels. As I said before, about a week ago (week 12 of tx) I was down to 26k but normally during tx I was in the 30s. (At 26k I still wasn't having bleeding problems). BUT I have cirrhosis and an enlarged spleen. So even when not on treatment my platelets are normally about 70k.

As I said my Hepatologist was going to have me reduce the PEG-ITFN down from 180 per week because of my low platelets. This is NOT something you want to do as it will affect chances of achieving SRV if done before becoming undetectable.
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Basics:
Platelets are clusters of proteins that act like bricks to form blood clots. They are produced by cells in the bone marrow. Platelet counts often drop if you are on interferon and ribavirin therapy. This can put you at a higher risk for bleeding.

If you have a low platelet count, you should pay particular attention to bleeding. Nosebleeds and bruises are more common. If you are concerned that you are bleeding or can't stop bleeding from a cut, seek medical attention.

Decreasing the interferon dose can help to improve the platelet count (your provider will advise you about this).
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THROMBOCYTOPENIA
A decrease in platelet count also may be observed in patients who are receiving interferons, and such decreases are more prominent with the peginterferonspeginterferons. The decrease is caused primarily by a reversible
bone marrow suppression, although autoimmunerelated thrombocytopenia may also occur. The concurrent use of ribavirin may blunt the thrombocytopenic
effect of interferons as a result of reactive thrombocytosis.
With peginterferons, the platelet count decreases gradually over 8 weeks, stabilizing thereafter and returning to baseline values within 4 weeks of stopping
therapy. Bleeding complications as a result of thrombocytopenia are uncommon.
In randomized clinical trials of the peginterferons, the rate of dose reduction attributed to thrombocytopenia ranged from 3% to 6%. However, most patients in clinical trials are carefully selected, and these trials excluded patients with more advanced
liver disease. Patients with cirrhosis may have baseline thrombocytopenia due to hypersplenism from portal hypertension, and these patients may develop
more significant decreases in platelet counts owing to bone marrow suppression during therapy. For these patients, an alternative approach to dose modification
would be beneficial to avoid dose reduction or discontinuation, both of which reduce the chance of SVR.

Best of luck my friend.
Hector

[redeemed1]

thanks for the info,i got a message from my dr. this morning saying she took the platelet count a few ways,and the more accurate measure was 70,which is a little better than 60.i agree with you about not reducing my double dose until und.,i want to attack this virus with as much as possible since the virus came back when i treated 2 years ago on a 48 wk. treatment with single dose peg. and riba.be blessed

[HectorSF]

Great news!!! Hang in there!

I hope your platelets stay stable. (At least until you become UND then you'll have the option of reducing Peg without impacting you chance of SVR).
Keep up the positive attitude!!!

I'm pulling for you!

Hector

[salvo]

Hey i was just informed from the drug copany that my med. will befor free and thanks to these people that told me what to do.I also have a problem with my platelets and they do not go up any more, they just stay around 70 and this is going to give me a problem I'm sure when I get started but have talked to a blood doctor already and she said, if they have to, they will give me platelets or a transfusion if needed but since this is a long process, dont know how it will turn out.I tried the older inteferon  abot 20 years ago and my blood would go up and down but now, just dont know.

[HectorSF]

So if I understand you correctly... when you are not on treatment your platelets are about 70k is that correct?
My platelets are also about 70k when not on treatment. I have cirrhosis; stage 4 liver disease with an enlarged spleen and moderate varices. Do you have cirrhosis? Low platelets can be a common symptom of cirrhosis.

2 weeks ago when I was at week 12 of tx my platelets when down to 26k. I was running out of platelets to lose! My Hep doctor said that my bone marrow had probably given all it could until it could produce any more. I'm a "null responder" so I stopped therapy anyway. So hopefully my platelets are heading back up to 70k again.

I must congratulate you on talking to your doctor before treatment and having a plan in place should your platelets go too low!!! Sounds like you have very good medical care. Having an agreement between you and your doctor BEFORE tx sets expectations so you won't be in the position of some patients who’s doc either have them cut back on meds (reducing their chances of SVR) or have them stop treatment all together. Not a surprise you want ot find out about in the middle of therapy!

I want to wish you the best of luck with your retreatment (you have better odds with PEG and Ribavirin then mono therapy) and hope you successfully clear the virus.
Hector

[Marcia2202]

This is what Bill posted in one of my threads. Might be of interest to you:

We do have a platelet booster here that has been approved for cancer treatment; it is generically known as oprelvekin (brand name Neumega), but its use has not been FDA approved for HCV treatment to my knowledge; it tends to worsen hemolytic anemia, although we have had a few patients in forum that have tried it.

Marcia