Low platelets

[tashka]

Dear Dr Schiano,

My husband has hepatitis C for many years. Last year he had several episodes of high bilirubin/itching, high AST/ALT, accompanied by dark urine, clay-colored stools, nausea, and weakness. We currently employ some alternative methods of treatment, and for a whole year he feels fine, there are no symptoms of any kind, and his bilirubin is normal. Everything else-albumin, protein, CBC values, INR-all normal. There are no signs of cirrhosis on CT scan, and no enlarged varices on upper endoscopy. Spleen is normal size. Only AST/ALT are elevated slightly.

Our only concern is low platelets. Last reading was 95.

Can the patient with long-standing liver disease have low platelets but do not have cirrhosis? Did you see patients in your practice with low platelets, but who are not cirrhotic? We did have biopsy in 2006, which showed stage I liver damage. We don't want to do another one.  

Thank you in advance for response.

[tashka]

Dr Dchiano, his father and brother both have platelet discorder of ITP type. From time to time their platelets drop to very low numbers. Thank you for the reply.

[Thomas D Schiano, MD]

patients with HCV could have ITP accounting for low platelets but much more common is that the person has advanced fibrosis accounting for the low platelets.  Obviously another primary hematological disorder could also be present. The NIH recommends that persons with HCV not actively receiving interferon-based therapies have liver biopsies performed every 4-5 years.  There is always the chance for sampling error with your previous biopsy.  if you are adamantly opposed to another biopsy than at least check a non-invasive marker of fibrosis such as FIBROsure, for peace of mind.