decreasing platalet count

[me_just34]

i have fatty liver diagnosed 1.5 years ago. at that time my liver enzymes were high but my platelet count was
191, 000/uL  ( normal range:  150, 000 - 400, 000.). From that time my diet was mainly vegetarian.
My liver enzymes improved my in my last test  2 days ago platelet count is 148, 000/uL.

What could be the cause of this last platelet count? diet or am I progressing to cirrhosis?
I will be happy for feedback.

[fntn]

Guess I missed that. With two different imaging studies not indicating any signs of advanced liver disease, I think you can be pretty sure that your doctors are comfortable with things and you don't have cirrhosis. But, again, you can have your liver stiffness measured to give you a peace-of-mind.

[me_just34]

my ct scan for liver  was done almost  1 year ago(february 2013)  not two years ago.

[fntn]

Using just your AST & platelet numbers - which is very little data to work with - it does seem to indicate some liver fibrosis maybe present. We're not doctors here and you should definitely keep following up with your doctors. If your last imaging study was done 2 years ago, I'd insist on having another as a followup. And, if things still remain suspicious and the new imaging doesn't indicate exactly what your status is, maybe get a fibro-test done (liver biopsy would be too extreme I think). Again, be sure to followup with your doctor. Take care.

[me_just34]

Yes they did for some  autoimmune and it was negative.
I do not remember details.  My hands change color and I think it is Raynaud.
I am now mainly concerned if my liver is damaged seriously or not.
I do not care Raynaud.

[fntn]

Have your doctors checked for any autoimmune activity, ANA testing, etc? Sometimes the CTD's can cause a variety of GI symptoms as well. Tracking that sort of thing can be tricky of course. The reason I bring it up is that you've mentioned the hand stress issues - sounds like Raynaud's but I maybe wrong.

The tuna fish is not a problem so certainly keep your diet under control as you've been able to do sometimes, wonderful progress there. I wouldn't expect the hepatic steatosis to resolve in that short a time period but the controlled weight plan and exercise is the way to fix that end of things.

[me_just34]

my full medical history is as follows:

I had right quadrant pain and wento to doctor  on November 07, 2012:  At that time, I was 74 kg and height 162 cm (BMI=28.2). 
FIRST TEST (November 07, 2012):
  bilirubine direct: 0.5 mg/dL (range:  0.-0.3]
  bilrubine total:  0.7 mg/dl (range: 0.2-1.3)
  ast:              97 U/L (range: 17-59)
  alt:               186 U/L (range: 21-72)
  alp:               92 U/L (range: 38-126)
  ggt:               81 U/L (range: 15-73)
  ldh:               641 U/L (range: 313-618),
  platelet count:  191, 000/uL ( range:  150, 000 - 400, 000.)
  ultrasound result:   Signs of hepatic steatosis,
Note: I do not drink alcohol. My gastro specialist suggested to lose weight and do exercices. After doing exercises and losing weight, I had the following tests with regular periods:

SECOND TEST (December 03, 2012)):
  bilirubine direct: 0.43 mg/dL (range:  0.-0.3]
  bilrubine total:  1.1 mg/dl (range: 0.2-1.3)
  ast:              61 U/L (range: 17-59)
  alt:               115 U/L (range: 21-72)
  alp:               85 U/L (range: 38-126)
  ggt:               45 U/L (range: 15-73)
  ldh:               512 U/L (range: 313-618),

  b12 vitamin:    209 ng/L (range: 191 -663 )


THIRD TEST (January  30, 2013)):
  bilirubine direct: 0.24 mg/dL (range:  0.-0.3]
  bilrubine total:  0.7 mg/dl (range: 0.2-1.3)
  ast:              34 U/L (range: 17-59)
  alt:               53 U/L (range: 21-72)
  alp:               81 U/L (range: 38-126)
  ggt:               28 U/L (range: 15-73)
  ldh:               480 U/L (range: 313-618),

After tthe hird test, the pain in my right quadrant was still existing and I asked my doctor to do a CT scan for right hand side organs on February 03, 2013 and it was
 totally normal for all  right hand side organs including liver .  I had gas, bloating, mucous in the stool problems (symptoms of  irritable bowel syndrome=IBS) and my doctor told me that the pain is not related to liver anymore and possible from IBS.


FOURTH TEST (April  22, 2013)):
  bilirubine direct: 0.26 mg/dL (range:  0.-0.3]
  bilrubine total:  0.8 mg/dl (range: 0.2-1.3)
  ast:              28 U/L (range: 17-59)
  alt:               44 U/L (range: 21-72)
  alp:               81 U/L (range: 38-126)
  ggt:               28 U/L (range: 15-73)

  platelet count:  161, 000/uL
  b12 vitamin:    187ng/L (range: 191 -663 )

For time period after fourth test, I was fine (no right side pain) for around  two months. At that time my weight was around 67 kg. I thought my health problems are solved and I gradually violated exercising and  diet. My weight increased with time and after two months of pain-free right hand side, I had right quadrant pain from time to time and all symptoms of irritable bowel syndrome. Before the fifth test below, my weight was 72 kg. Moreover, one month before fifth test, to increase my b12 level I consumed 3 canes of tuna fish every week during one month. This resulted  in an increase in B12 level  as seen.  Howeever, as seen in the fifth test below, my liver enzymes increased again and I am not sure if this increase is realated to weight gain or consuming tuna fish since tuna fish includes toxic mercury.

FIFTH TEST (January  07, 2014)):
  ast:              50 U/L
  alt:               101 U/L
  alp:               71 U/L
  triglyceriden:   45  mg/dL (range: 70-170)
  cholestrol:      204 mg./dL ( range: 0-190).
  hdl cholesterol: 58 mg/dL   (range: 35-55)
  ldl cholesterol:  137 mg/dL   (range: 0- 115)
b12 vitamin:    398 ng/L (range: 191 -663 )
After fifth test, then, again I did a strict exercise and diet program  plus weight loss. Before the sixth test below,  my weight was 66 kg.


SIXTH TEST (March  14, 2014)):

  platelet count:  172, 000/uL z
  bilirubine direct: 0.2 mg/dL
  bilrubine total:  0.74 mg/dl
  ast:              33 U/L
  alt:               37 U/L
  alp:               71 U/L

From the period of sixth test to present, my right side quadrant pain  is almost zero and my irritable bowel syndrome symptoms improved. I further reduced my weight to 64 kg before the seventh test. However, I started to have cold/strsss sensitive hands and my palms become blue/purple in cold wathers and when I am streesed . In general, I am stressed either due to my health problems or due to my work. Moreover, recetnly I started to feel left chest pain and pain in left arm from time to time. I went
to emergency  for seventh test below. They  did some tests but said no problem in heart.

SEVENTH TEST (May  24, 2014)):

   platelet count:  148, 000/uL,   range:   166, 000/uL - 308, 000/uL.

   b12 vitamin:    229 ng/L (range: 191 -663 )
   ast: 27
   alt: 32
   alp 82:
   gamma-gt: 21
   ldh   :497

so far no any jaundice. I think I was overweight in last 4 years.

[fntn]

How long have you been over weight with the elevated BMI? Have you ever noticed episodes of dark urine in the recent past? I noticed that one of your blood tests caught an elevation of direct bilirubin but the total bilirubin was normal (... and you've not reported any jaundice). The high direct bilirubin can be excreted by your kidneys so any other, untested elevated episodes might have been noticed in the bathroom. The direct bilirubin elevation can be caused by NASH as well as various types extrahepatic obstructions. It's interesting that your ALP hasn't shown elevation in any of the testing and when combined with the fact you've not reported any pain, the obstruction is likely to be minor - if there of course. Also, the steady decline of your platelets over a couple of years is something the doctor should interested in - assume that you have been going to a GI or Hep?

[me_just34]

I just used vitamin supplements. my blood history is as follows:

blood test on November 07,  2012 (overweight with BMI: 29):  
     platelet count:  191, 000/uL
     bilirubine direct: 0.5 mg/dL (range:  0.-0.3]
     bilrubine total:  0.7 mg/dl (range: 0.2-1.3)
     ast:              97 U/L (range: 17-59)
     alt:               186 U/L (range: 21-72)
     alp:               92 U/L (range: 38-126)
     ggt:               81 U/L (range: 15-73)
     ldh:               641 U/L (range: 313-618),
    
After that  the above test gradually lost weight:

blood test on April 22, 2013:    
     platelet count:  161, 000/uL .
     b12 vitamin:    187ng/L (range: 191 -663 )
     bilirubine direct: 0.26 mg/dL (range:  0.-0.3]
     bilrubine total:  0.8 mg/dl (range: 0.2-1.3)
     ast:              28 U/L (range: 17-59)
     alt:               44 U/L (range: 21-72)
     alp:               81 U/L (range: 38-126)
     ggt:               28 U/L (range: 15-73)

Weight increased after the above test. I thought my health problems were solved.

blood test on March 24, 2014:  
     platelet count:  172, 000/uL .
     bilirubine direct: 0.2 mg/dL
     bilrubine total:  0.74 mg/dl
     ast:              33 U/L
     alt:               37 U/L
     alp:               71 U/L

Again started to exercise and lose weight after the above test.

blood test on May 24, 2014:        
    platelet count:  148, 000/uL .
    b12 vitamin:    229 ng/L (range: 191 -663 )
    ast 32 U/L
    alt 27 U/L
    alp 82 U/L
    ldh 497 U/L


  

[Dee1956]

Hi I would ask your doctor what it means as he/she had your entire picture. I was diagnosed with  liver damage due to my low platelets.
Yours are still in the range, mine had fallen to 65K.  Are you on any aspirin or NSAIDS like Advil?
That can affect your platelets.  My blood specialist told me that aspirin can paralyze your platelets for one week, Advil for 3 days.
Take care
Dee