low platelets post transplant...

[happymom2v]

Is it common to have low platelets a few weeks post transplant? The platelet count has been trending downward the last few weeks. It was well in the low 100,000's after transplant and began to slowly trend downward. The platelets are now in the mid 30k. A vascular liver ultrasound was done to rule out any clots or blockage...thankfully, the u/s shows good blood flow, etc. The spleen appears to be enlarged...especially for such a petite person.
Prior to transplant, the platelets were always low, which ranged in the 50ks. But I know that was due to the cirrohic liver and enlarged spleen. Not sure what's causing the decrease of platelet count now?

Could it be possible that something else is going on?

Bactrim..."might" this be contributing to low platelets??? Can you share any information or experience with Pentamidine vs. Bactrim?

At this point...I can't help but STRESS...ugh!!!

[Thomas D Schiano, MD]

bactrim prevents infection so is prophylax.  this is a reasonable rise in the platelets.  bactrim may be the predominant cause--you dont need a bone marrow biopsy.

[happymom2v]

Since stopping the Bactrim (one week ago) the platelet level has begun to increase...it was 38,000 last Monday then increased to 43,000 on Thursday and 54,000 yesterday. Is this the upward trend that is typical from stopping Bactrim? Based on these numbers, does it seems that the Bactrim is the cause of the recent low platelet count? Is a bone marrow necessary to check for any other issues that may be contributing to the low platelets?

[happymom2v]

What do you mean by "infection prophylaxis"?

[Thomas D Schiano, MD]

very few if any patients have long term problem with the platelets.  its early after the transplant-I think that you will be OK.  there are different philosophies about the duration on infection prophylaxis

[happymom2v]

Thank you so much Dr. Schiano.
I do have some additional questions...

I was under the impression that the Bactrim would be "life long". Isn't it risky to not be on an antibiotic type medication long term?

Once the spleen has been enlarged prior to transplant, will it always be an issue long term with decending platelet count?

I am concerned that if the platelets keep dropping, the spleen will need to be removed. What determines if the removal of the spleen is necessary?

[Thomas D Schiano, MD]

i dont think taht you need to see a hematologist right now--this is typical in the post-liver transplant setting at this stage.  pentamidine is just as safe as bactrim--a lot depends on your program's prrotocol as to how long this prophylaxis is required.  We stop it after 6 months but some programs continue life-long. the spleen may or may not shring back to normal size

[happymom2v]

Thank you so much Dr. Schiano for your response. I do have a few more questions...

Should I make an appointment with a hematologist to rule out any other issues contributing to the low platelets? Is it possible low platelets are due to the enlarged spleen? Will the spleen ever shrink back to a "normal" size?
At what # should we get concerned about the platelets being too low???

Cellcept was discountined bc it caused diarreha. What are your thoughts regarding the Pentamidine versus the Bactrim?

[Thomas D Schiano, MD]

it is not unusual for the platelets to decrease after liver transplantation--meds such as bactrim, cellcept and others can contribute.  Sometimes the platelet count will not return to normal after the transplant and the spleen may not return to normal size